SMLE Surgery

From November 2021 to June 2022

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A 65-year-old heavy smoker is coming for a general examination. What is the best screening test for him?
A. Osteoporosis
B. Colon cancer
C. Abdominal Aortic Aneurism

Male patient came with scalp open wound, after 6h assault, what wound management?
A. Secondary closure
B. Debridement with Primary closure
C. Debridement with granulation
D. Leave it for granulation

Patient had Pancreatitis 6 weeks ago, now complain of epigastric pain and tenderness, US revealed
mass with thick wall and fluid, WBC high, what is the diagnosis?
A. Pancreatic Pseudocyst
B. Pancreatic Abscess
C. Walled off necrosis

Patient diagnosed with Ulcerative Colitis 6 years ago. when to be screened for colon cancer?
A. Annually till age of 50
B. If there is mild inflammation
C. At time of diagnosis
D. 8-10 years after diagnosis

Child presents with hip and groin pain. An US was done to reveal hip joint effusion. He is afebrile. What
is the most likely diagnosis?
A. Toxic synovitis
B. Benign acute myositis
C. Osteomyelitis
D. Septic arthritis

The World Health Organization (WHO) published the WHO Surgical Safety Checklist in 2008 in order to
increase the safety of patients undergoing surgery. The Checklist consists of three phases of surgical
procedure:
A. Before admission, Before skin incision, at discharge from hospital.
B. Before admission, before induction of anesthesia, at discharge from hospital.
C. Before induction of anesthesia, Before skin incision, Before patient leaves operating room.
D. Before admission, Before induction of anesthesia, Before patient leaves operating room.

Patient came after 3 days after Roux-En-Y surgery complaining of fever chill and left shoulder pain,
best diagnostic investigation?
A. CT with contrast
B. Endoscopy
C. Laparoscopy
D. exploratory laparotomy
Which of the following is true regarding necrotizing pancreatitis?
A. increased lipolysis
B. Hypoglycemia
C. Decreased gluconeogenesis

Trauma patient with extra peritoneal bladder injury, what next step in management?
A. Suprapubic catheter
B. Urgent exploration and repair
C. Catheter repair and assess after 2 weeks
D. Catheter us after 2 weeks

Patient was extubated after thyroid surgery and immediately developed shortness of breath and
respiratory distress. Examination reveals that both vocal cords are in a semi- closed position. How will
you secure the airway?
A. Cricothyroidotomy
B. Tracheostomy tube
C. Re-intubate the patient

Which of the following indicates compensated shock?

A. Anuria
B. Confusion
C. Hypotension
D. pale peripheries

Pelvic Fracture with injury to membranous part of urethra. Blood seen in external meatus. What is the
most appropriate action?
A. Cystoscopy Similar recall
136-• Rt neck lump 10cm spongy in palpating, fna show lymphatic uid
B.
C. Suprapubic catheter A- Surgery
B- Sclerotherapy
D. CT pelvis C- Chemotherapy
D- Radiotherapy

Lymph Node swelling and was clear lymphatic fluid in this swelling. What to do?
A. Surgery
B. Sclerotherapy
C. Radiotherapy
D. chemotherapy

Old patient came with subdural hematoma with signs of lateralization imaging revealed 13 mm shifting.
his GCS 7/15 then was intubated and resuscitated what to do next?
A. IV mannitol
B. Admit ICU and observe
C. Craniotomy
D. Insert intracranial monitor
Patient involved in Road Traffic Accident (RTA) with multiple mandibular fracture with sever
bleeding, unconscious, no vitals mentioned How would your mange his Airway?
A. Laryngeal mask
B. Orotracheal
C. Nasotracheal
D. Cricothyrotomy

Long case of a medullary thyroid cancer (diagnosis given) what is the appropriate management?
A. Subtotal thyroidectomy
B. Total thyroidectomy
C. Hemithyroidectomy

55 years old patient was diagnosed with autoimmune thyroiditis, with a history of progressive
enlargement of right lobe of the thyroid. FNA report: malignant cells. Which of the following is most
likely the type of thyroid malignancy?
A. Papillary
B. Medullary
C. Anaplastic
D. Lymphoma

Patient with hemorrhoids that is reduced on its own. the grade?

A. 1st Degree
B. 2nd Degree
C. 3rd Degree
D. 4th Degree

Lactating women present with right breast pain for 6 day on examination, hot tender swelling lateral to
the right areola Pt started to take floxacillin Ultrasound showed Cystic lesion, thickened content, What
next?
A. Incision and drainage
B. Repeated aspiration
C. Excisional biopsy
D. Reassurance or antibiotic

68-year-old man has been advised to undergo surgical treatment for a leg reducible inguinal hernia. What
is the treatment?
A. Open Mesh Repair

Diabetic patient with pseudo hyper epithelializing in situ, what you should do:
A. Amputate toe
B. Ulcer Debridement
C. Follow up
D. Repeat biopsy
Pt with hepatic benign tumor dx is hemangioma, decided to be managed Conservatively, but we should
advise the patient to?
 A. Avoid contact sport and trauma
B. Loss weight
C. Smoking cessation

50 years old male patient, alcoholic, with Abdominal pain and palpable gallbladder, weight loss, scenario
suggestive of malignancy. Liver enzymes acceptable except for significantly high ALP. Diagnosis?
E. Periampullary Tumor
F. Hepatocellular CA

Patient post foot crush injury with heavy object came with excruciating pain and pale cool limb, Best next
step:
A. X-ray
B. CT scan
C. Compartment pressure

Old male patient did total thyroidectomy he developed swelling in the neck with inspiratory stridor and
Shortness of breath in the ward, how you will manage?
A. Thoracotomy
B. Surgical exploration
C. Drainage

Patient had a stab wound in the chest. Came with weak thread pulses, raised JVP, Equal Bilateral Air
Entry in both lungs. What's the diagnosis?
A. Pneumothorax
B. Cardiac tamponade
C. Pulmonary contusion

Patient with history of sleeve bypass with history of leak, present with severe pain and hypotension, next
step?
A. Endoscopy
B. US
C. laparotomy
D. Diagnosis laparoscopy

Case with history of blood coming from ear and perforation tympanic membrane, what is the cause?
A. Basal skull
B. Subarachnoid hemorrhage

Male victim of gunshot to the thigh, pale and unconscious, BP 90/60 pulse 130, next step?
A. Orotracheal intubation
B. Blood transfusion
C. Shift to OR
D. RL infusion
Patient with anal fissure not responding to drug, what procedure is most suitable for his condition?
A. Lateral internal sphincterotomy
B. Anal curettage

Picture of Two huge echinococcosis , asking what most

appropriate initial step?
A. Albendazole
B. Surgical deroofing
C. Percutaneous drainage
D. Liver resection

Best way to assess patient spine after Road Traffic Accident?

A. CT spine

Patient fell on outstretched hand, pain at anatomical sniff box, which bone fracture is it?
A. Colles
B. Scaphoid
A 45-year-old with history of pancreatitis, then recurrent vomiting, + upper GI bleeding After
resuscitation what should be done Splenomegaly, normal portal, thrombo-splenic. He became stable after
injection of sclerotherapy, which of the following best way to management?
A. Splenectomy
B. Splenorenal shunt
C. Venocaval shunt or portocaval shunt
D. None

Cirrhotic patient complicated came with portal hypertension, came with upper GI bleeding due to varices
diagnosed by Upper Endoscopy, what to give after resuscitation?
A. Somatostatin
B. Terlipressin
C. Octreotide
D. None

A26 year old male came to ED with epigastric pain relieved by eating and worsening by fasting, which of
the following next step in first investigation?
A. Abdomen US
B. Upper Endoscopy
C. Urea breath test
D. Blood antigen for H. Pylori

Patient after Motor vehicle accident at ER, vitally stable, on examination showed Lift hypochondrium
tenderness and ecchymosis What is the Most Appropriate test:
A. CT
B. FAST
C. DPL
D. Laparotomy

76 years old male with reducible inguinal hernia and moderate pain,
A. Open mesh repair
 B. Non-surgical procedure
C. Simple repair

47-
A. KUB X Ray
B. Ultrasound
C. CT
D. MRI

There was a question about a lady known case of gallstones for 15 years presented with abdominal pain
and fatigue There was air in biliary system, what is the diagnosis?
A. Gallstone ileus
B. Acute Cholecystitis
C. Acute pancreatitis

65 years old female, with Asymptomatic femoral hernia. What is the most appropriate management?
A. Observation
B. Open repair with mesh
C. Laparoscopic repair

45-year-old male patient underwent appendectomy after signs and symptoms of appendicitis.
Histopathology report: tip of the appendix carcinoma. What is the appropriate management?
A. Observation.
B. Chemotherapy
C. Radiotherapy
D. Right hemicolectomy

About a fistula with discharge, located posterior to anal sphincter what is your management?
A. fistulogram
. B. fistulotomy
C. lateral internal sphincterotomy
D. MRI

Patient known case of ulcerative colitis did MRCP and showed intra and extra hepatic duct strictures,
what is the diagnosis?
A. Cirrhosis
B. Primary biliary cholangitis
C. Primary sclerosing cholangitis

Patient had Blunt trauma, patient is stable, FAST showed intraperitoneal fluid. Next step?
A. Exploratory laparotomy
B. CT

Truck driver with severely painful gluteal swelling, management?

A. Aspiration
B. Abx
C. Observation
D. Incision and drainage
Patient have Fever, high WBC, lactate is 3, mean arterial pressure was 65 and was maintained on
vasopressin, what is best describe his condition?
A. Bacteremia
B. SIRS
C. Sepsis
D. Septic Shock

Case of multiple gastroduodenal ulcers with UGIB, asking about what lab test to do:
A. Fasting Gastrin
B. VIP

25 yeas old breastfeeding women with breast pain tenderness and swelling but there is no fluctuation
What is your management?
A. Aspiration
B. Incision and drainage
C. Antibiotic

51 years old female medically & surgically free, with no family history of colon cancer, which colon
cancer screening test is appropriate for her?
A. 5 years Colonoscopy
B. Annual Fecal Occult Blood
C. Annual sigmoidoscopy

50 years old female presented to ER with sudden left lower chest pain and epigastric pain, after forceful
vomiting. On examination there was decreased breath sound in the left lower chest What is the most
likely concern?
A. Pneumonia
B. Pneumothorax
C. Aspiration
D. Esophageal Perforation

Elderly smoker known case of poorly controlled DM comes with ulcers on tip of three of his toes,
?
A. Amputation
B. Long term anticoagulation
C. Immediate surgical intervention
D. Diet modification and lifestyle changes

Patient obese and tried to lose weight with diet and exercise but failed. His BMI 43, and his HA1C is 8.5,
What is the most appropriate advice?
A. Bariatric Surgery

Elderly known case of poorly controlled DM comes with ulcers on tip of three of his toes, diminished
dorsalis pedis the initial management:
A. Amputation
B. Negative pressure dressing
C. surgical intervention
D. Debridement
Case of right flank pain hematuria pain full micturition can't recall best next step:
A. CT with oral and IV contrast
B. CT without contrast
C. US kidneys

Patient came after limb trauma, with severe pain and paresthesia between his toes and it was pale. X ray
shows fractures, intercompartmental pressure was 35mmhg what to do?
A. Internal fixation
B. Closed reduction
C. External fixation
D. External fixation with four fasciotomies

Post-appendectomy, 2 cm carcinoid found on the tip of the appendix, what is your management?
A. Observe and follow up

Post left thyroid lobectomy female patient complaining of sever shortness of breath after the surgery and
pointing to her neck, what is next step?
A. Take her back to OR
B. Bedside tracheostomy
C. Nasal cannula
D. open sutured wound and evacuated in ward

Case about pleural effusion on chest tube after a while there was blood in the water under seal
(Hemorrhagic Pleural Effusions and Hemothorax), how to manage?
A. Thoracentesis
B. Tube thoracostomy (chest tube)
C. Thoracotomy

65 male known case Atrial Fibrillation Presented with severe abdominal pain on examination there was
abdominal tenderness her labs showed 23000 WBC what to do?
A. US
B. MRI
C. CT
A. Laparoscopy

12-year-old boy injured with supracondylar fracture and distal radial pulse absent, which of the following
is the appropriate next step in management?
A. K wire
B. intramedullary nail
C. Surgical exploration
D. Closed Reduction

Football players during a pass developed sever Right iliac fossa pain and swelling / irreducible, what is
the management??
A. Needle aspiration for hematoma
B. laparotomy

Man came with scalp open wound, after 6h assault, what wound management?
A. Secondary closure
 B. Debridement with Primary closure
C. Debridement with granulation
D. Leave it for granulation (not sure)

Adult soldier with bilateral inguinal swelling with positive cough impulse what is the most appropriate
management?
A. Laparoscopic repair
B. Herniotomy
C. Open hernia repair and mesh
D. Observation

Elderly female that has back, and she is stooping and bending her back while she walks to relieve the
pain. What is the diagnosis?
A. Lumbar spine stenosis
B. Degenerative Lumbar spine

Something years old patient came with history with middle line neck swelling that move up and down
with tongue protrusion what is the diagnosis?
A. Brachial cyst
B. Thyroglossal cyst
C. Zenker diverticulum

Patient is toxic, Temp. 37.9 (it was elevated) WBC high, bilirubin high, US: cystic lesion without septates
CT: appropriate
Management?
A. Early laparoscopic cholecystectomy
B. Emergent stent chole
C. Cholecystectomy after 3 months

Young patient underwent open appendectomy, stayed in hospital for 2 days post op and it was uneventful
stay. Came back on the 8 the day with surgical site pain on examination abdomen was soft and lax, tender
in opposite with redness noticed, what would be your next step?
A. Exploratory laparotomy
B. Open drainage
C. CT abdomen
D. Oral Antibiotics

Patient came fracture and compartment syndrome, the first alarming sign?
A. Absent pulse
B. Toe discoloration
C. Paresthesia

Traumatic patient presented to ER with Profuse bleeding from nose and mouth, cyanosed with decreased
breath sound on right side of the chest. Mostly was unstable Which of the following is the most
appropriate next step
A. Right chest thoracostomy
B. Intubation
 C. IV fluid resuscitation and O type blood transfusion

Charcoal triad is specific for which disease?

A. Cholangitis
B. Appendicitis
C. Pancreatitis

A 24-year-old lady presents with a hard, mobile well-circumscribed painless left breast mass that has been
increasing in size from the past few months and was NOT related to her menstrual cycle. The most like
Diagnosis is?
A. Fat cyst
B. Fibroadenoma
C. Fibrocystic changes
D. Intraductal papilloma

Patient obese, history of jaundice for 1 week with anorexia and abdominal pain, examination showed
right upper quadrant tenderness, no history of medication or disease, what is initial step?
A. MRCP
B. Abdominal US
C. CT
D. Biopsy

30 years old man underwent appendectomy day post-operative complaining of pain at the site of the
wound. The wound was red, swollen, tender What will you do?
A. Open wound
B. Aspiration
C. US
D. IV fluid

Patient with penetrated neck in the zone 1 and is bleeding what is the best management?
A. Open and primary repair
B. Endovascular
C. Open and ligation

Patient post RTA chest X-ray shows 3rd ,4th ,5th 6th rib fracture with no pneumothorax what is the next
step?
A. Adequate Analgesia
B. Chest tube
C. Thoracotomy

Patient post-surgery developed left limp edema up to the thigh, which anticoagulant to be given?
A. UFH (there were no LMWH or Heparin)
B. Alteplase
40 years old woman with no pain but you noticed jaundice. She has high direct bilirubin and high ALT
what is your diagnosis?
A. Carcinoma in head of pancreas
Patient diagnosed with tubular colon tumor in the sigmoid colon, which was respected completely with
safe margins, what is the next step?
A. Follow up 3-6 months
B. Sigmoidoscopy
C. Segment colectomy
D. Fulguration of the tumor

Male in his 20s has fever, epigastric pain jaundice there is epigastric tenderness, abdominal US showed
hypodermic mass with peripheral enhancement, what is the management?
A. Metronidazole
B. Percutaneous drainage
C. Surgical drainage
D. Antibiotic or follow up not sure

Patient Has ischemic heart disease came with sudden severe abdominal pain in the left iliac fossa and
tenderness, HCo3 normal, low PH
A. Diverticulitis
B. Mesenteric ischemia
C. Perforated viscous

A 60 years old patient with difficulty swallowing liquid, pain on swallowing, and regurgitation. What is
the most diagnostic test?
A. Barium swallow
B. Lower esophageal sphincter manometry
C. CT

A woman with a left breast mass for 9 months she underwent Mammogram and it showed: spiculated
mass with suspicious microcalcification and axillary lymph node involvement, BI-RAD V, next step?
A. Excisional biopsy
B. Core biopsy
C. Modified radical mastectomy.

You attended the surgery theater as intern, (some renal surgery) and the surgeon was preparing to do the
surgery on the right side, but you knew from the history that the diseased kidney is the left one. What
should you do?
A. Call the chef intern
B. Tell the surgeon
C. Do nothing
Adult fell from height complains of severe heel pain. He is conscious, oriented and has stable vitals. What
is the next step?
A. Pain control
B. Lower limb X-ray
C. Pulse palpation

Elderly Patient come with severe headache to ER then suddenly deteriorated and decrease level of
consciousness CT done was hematoma, best Management?
A. Admit to ICU
B. Give mannitol
C. Evacuates

Patient sustained a chest stab wound injury, on examination there was Stony dullness over right chest and
tracheal deviation to the left, what is the diagnosis?
A. Open pneumothorax
B. Tension pneumothorax
C. Massive Hemothorax

28 years old patient medically free presented to the ER with hx of abdominal pain nausea anorexia and
lower quadrant abdominal pain vitally stable CT: diverticulitis with 20 ml fluid 2*2 cm What is the most
appropriate management
A. Exploratory laparotomy with Sigmoidectomy
B. Exploratory laparotomy with easy content
C. Conservative IV antibiotics
D. Diagnostic laparoscopy

30 years old man underwent appendectomy day 6 post-operative complaining of pain at the site of the
wound. The wound was red, swollen, tender What will you do?
A. Open wound
B. Aspiration
C. US
D. Antibiotic

Patient had central abdominal stab wound, he is vitally stable,

A. CT abdomen
B. Exploratory laparotomy
C. FAST

Patient with abdominal pain, vitally stable, imaging shows: increase thickness of sigmoid and thumb print
due to edema. What is the next step?
A. Colonoscopy
B. Diagnostic laparoscopy
C. Exploratory laparotomy
Trauma patient, currently well. lucid interval reported by paramedics, now he is deteriorating. Most likely
diagnosis?
A. Epidural hematoma
 B. Subdural hematoma
C. Base of skull fracture

Spleen injury in a child but hemoglobin is low level 110, what to do?
A. Conservative
B. Give hemoglobin
C. Splenectomy
D. Splenorrhaphy

Post RTA patient had lower back pain and unable to move, management done while waiting for the
consultant?
A. CT spine
B. Back stabilization

Patient with Symptoms and sign of bowel obstruction, On the way to CT he has Upper GI bleeding
Next step in management:
A. Endoscopy
B. Colonoscopy
C. CT
D. Laparotomy

Male patient in his 20s, present with sever epigastric pain for 6 hours, start suddenly. On examination
there is diffuse tenderness, sluggish bowel sound. Labs: high WBCs, Amylase 300, Which of the
following best initial diagnostic step?
A- Erect chest X-ray
B- Abdominal X-ray
C- Abdominal CT
D- Abdominal US

Patient of stab wound measuring 2 cm penetrating injury with omentum coming out, patient is vitally
stable, CT report negative findings, Next step management:
A. Observation
B. Close the wound
C. Leave the wound open
D. Laparotomy

Patient present with abdominal pain, vitally stable, imaging shows: increase thickness of sigmoid and
thumb print due to edema. What is the next step?
A. Colonoscopy
B. Diagnostic laparoscopy
C. Exploratory laparotomy

Anterior duodenal perforation case, what is the management?

A. Omental patch
B. Gastrojejunostomy
C. Partial gastrectomy

A scenario about hydatid cyst measuring10*13 in Right lobe with daughter cysts, what is the most
appropriate definitive management?
A. Surgical deroofing of cyst
 B. Percutaneous aspiration
C. Right hepatectomy

Case of Pelvic fracture. Imaging revealed: fracture in right upper part of right pelvis and extraperitoneal
bladder injury, what is the management?
A. Immediate repair
B. Suprapubic catheter
C. Catheter drainage and definitive repair in 14 days.
D. Catheter for 14 days then repeat imaging

Patient post trauma has distended neck vein that does not move with respiration in well his cardiac output
2.5 liter, what is the type of shock?
A. Cardiogenic
B. Hypovolemic

A 55-year-old man presents with fever and pain in the perineal region. Upon further questioning he also
complains of frequency, urgency, dysuria, and a decreased urinary stream. On physical examination his
abdomen is soft, nondistended, and nontender. Digital rectal examination demonstrates sever tenderness
on the anterior aspect. Laboratory examination reveals leukocytosis and findings on urinalysis are
consistent with a bacterial infection. Which of the following is the most likely diagnoses?
A. Urinal tract infection
B. Benign prostatic hyperplasia
C. Prostatitis
D. Pyelonephritis

Road Traffic Accident (RTA) case with injury to thoracic vertebrae (T9) with paraplegia, breathing
?
A. Give IVF
B. Intubation

30 years old man underwent appendectomy day 6 post-operative complaining of pain at the site of the
wound. The wound was red, swollen, tender What will you do?
A. Open wound
B. Aspiration
C. US
D. IV fluid

50 years old male complained of right iliac fossa dull aching pain. Exam showed that he had right
iliac fossa mass with positive cough impulse. The examining doctor found a bluish
tinge on the mass surface and the percussion tab was positive. The most likely diagnosis is?
A. Right inguinal hernia
B. Right femoral hernia
C. Right vaginal Hydrocele
D. Cyst of morgagni
E. Saphena Varix

A 32-year-old man presents with an asymptomatic mass in his right testicle, On examination, the mass
cannot be transilluminated ultrasound showed a solid mass in the right testicle. Which of the following is
the most accurate method in obtaining a diagnosis of testicular cancer?
A. Serum levels alpha fetoprotein and beta human chorionic gonadotrophin.
B. Percutaneous biopsy of the testicular mass
 C. Incisional biopsy of the testicular mass through a scrotal incision
D. Radical inguinal orchiectomy

Adult soldier with bilateral inguinal swelling with positive cough impulse what is the most appropriate
management?
A. Laparoscopic repair
B. Herniotomy
C. Open hernia repair and mesh
D. Observation

Most affected nerve in patent ductus arteriosus (PDA) surgery?

A. Phrenic Nerve
B. Vagus Nerve
C. Left Recurrent laryngeal Nerve
D. Cardiac plexus

Patient had a RTA and present to the ER, initially was oriented and asking about water and then he
became confused his blood pressure was 80/60, Heart Rate 14, what stage of hemorrhagic shock he is in?
A. Class I
B. Class II
C. Class III
D. Class IIII

Open book pelvic fracture case, what is the best fluid type to give?
A. Normal Saline
B. Ringer Lactate
C. D5 10%

Traumatic patient presented to ER with Profuse bleeding from nose and mouth, cyanosed with decreased
breath sound on right side of the chest. Mostly was unstable Which of the following is the most
appropriate next step.
A. Right chest thoracostomy
B. Intubation
C. IV fluid resuscitation and O type blood transfusion.

36 years old patient with left neck mass, 2x2xm in posterior angle of mandible US: normal thyroid, left
large LN with cystic component FNA: all smear shows follicular thyroid, what is the diagnosis?
A. Metastatic thyroid cancer
B. Apparent thyroid
C. Ectopic thyroid
D. Thyroglossal cyst

Patient had appendiceal mass he was treated non-operatively and discharged home with antibiotics, next
step in management?
A. No further intervention
B. Open appendectomy after 2 weeks
C. Laparoscopic appendectomy after ___ weeks (I forget how many week)
Patient post appendectomy, came for regular follow up post-surgery, no active complaints, on exam he
has seroma which drains freely from the opening of the wound, no erythema no pain no fever, what is the
appropriate management?
A. Observation
B. Open wound exploration
C. Regular wound dressing
D. US guided drainage

Thyroid Cancer case had mixed component solid and cystic, total size 2*3cm, solid 2 cm What best
modalities to reach the diagnosis?
A. Core biopsy from solid
B. FNA aspiration from cyst

Inferior lateral Injury to the knee causing fracture of head of fibula, Which nerve could be injured?
A. Tibial nerve
B. Common peroneal nerve
C. Deep peroneal nerve
D. Femoral nerve

Patient had motor bike accident with mid shaft fracture of femur, he is conscious, Oriented. What to do
before fixation?
A. Sedation
B. Analgesia
C. Call operation room
D. exam pulse

18 years male came with STAB wound injury next to umbilicus with small opening clean and bleeding
stopped, vitally stable with normal lab results, CT scan report showed: small splenic laceration with
minimum fluid surrounding it, what is the best definitive management?
A. Wound closure
B. Antibiotics
C. Splenectomy
D. Exploratory laparotomy

Patient had stab injury in front of R or L ear loop near or below angle of mandible there oozing of blood,
on examination patient is conscious and alert, what is the next step?
A. Surgical exploration
B. CT angiogram
C. US

A patient underwent a hernia repair operation 12 years ago, now presents with signs of intestinal
obstruction. Which of the following is the most likely cause?
A. Improper Repair
B. Late Onset Crohn's
C. Adhesions
D. Cause Is Irrelevant to The Prior Surgery History
Patient involved in RTA with isolated head injury, he remains in coma for 5 days after the accident, what
is the appropriate to resuscitate him in early management?
A. NGT
B. Gastrostomy tube feeding
C. Central line
D. Peripheral line
Patient with stab wound in anterior neck, he is Alert but in labs oxygen sat 82%. What to do?
A. Oxygen mask
B. Cricothyroidotomy
C. Endotracheal intubation
D. Tracheostomy

Patient after trauma have shortness of breath and decrease air entry in left lobe and the left lung was hyper
resonant to percussion. What is the next step?
A. Chest tube in left side.
B. Needle decompression.
C. PA, lateral chest x ray.

Victim in RTA who did Ureteroscope urethrogram and found injury in the bulbar, what do you want to do
next?
A. A-Suprapubic catheter
B. B-Foley catheter

Patient post RTA with cervical emphysema, decrease air entry and pneumomediastinum, what's the
diagnosis?
A. Tension pneumothorax
B. Tracheobronchial injury
C. Simple pneumothorax
D. Open pneumothorax

Patient had liver laceration and the patient is hemodynamically unstable. What to do?
A. Right hepatectomy
B. Perihepatic packing
C. Right hepatic artery ligation
D. Ligation of the involved vessel

Old patient in Intensive Care Unit (ICU) with acalculous cholecystitis, what is the best management for
him?
A. Cholecystectomy tube
B. Lap chole
C. Open chole

12-year-old received a nonspecific blunt trauma on his abdomen and later presented with generalized
abdominal pain. Imaging of the spleen showed a 7 mm hematoma and 4 cm tear (grade 3). Your
management is?
 A. Splenectomy
B. Spleen preserving surgery
C. Conservative

Child presents after trauma. CT scan shows minimal abdominal fluid collection and grade 3 splenic
injury, patient stable, what is the management?
A. Two units of PRBCs
B. Non-operative
C. Splenectomy
D. Splenic preservation survey

Patient found to have anal Most common anal fistula internal opening is ?
A. Left lateral
B. Medial posterior
C. Medial anterior

A female get high energy accident (high velocity) with seat belt sign , On X-ray has chance fracture, what
will associated with this fracture?
A. Duodenal perforation
B. Gastric perforation
C. Jejunum perforation
D. Vena cava perforation

Patient post esophageal dilatation 8 hours later present with chest pain and voice change?
A. Hemorrhage
B. Perforation
C. Aspiration

Patient with blunt chest injury resulted in fracture in 3rd, 4th and 5th ribs in more than one site. What is
the initial treatment?
A. Intubation
B. Assisted ventilation
C. IV fluid.

Patient did a right inguinal hernia repair month ago, now presenting with a shrunken right testicle. What
is the cause of his presentation?
A. Mesh prolapsed into the scrotum
B. Thrombosis of the pampiniform plexus
C. Tight external ring of the inguinal canal

Male patient complains of episode of hematemesis. normal past medical history Labs show mild anemia,
all labs are normal except elevated urea level in blood, what is the diagnosis?
A. Mallory Weiss syndrome
B. Erosive gastritis
C. Peptic Ulcer Disease
A patient presents with pain and an itchy anus after defecation, as well as painful defecation with streaks
of blood in his stool. What is the most likely diagnosis?
A. Abscess
B. Anal Fissure
C. Thrombosed piles above and medial = indirect inguinal
D. Fistula above and lateral= direct inguinal

Below and lateral = femoral

Which type of hernia above and lateral to pubic tubercle?
A. Inguinal
B. Direct
C. Femoral
D. Obturator

Patient underwent hernia repair with mesh, came now complaining of pain extending to the thigh
associated with numbness and paresthesia, what to do?
A. Remove the mesh
B. Remove mesh with neurectomy
C. Nerve block
D. NSAID

Case of Pancreatitis 5 weeks ago. Now she has epigastric tenderness and cannot tolerate food with
vomiting each time. By ultrasound, you found large about 12x10 cm mass with thick wall and fluid inside
which is heterogenous and non-liquefied. Labs: 346 amylase, WBC 15000. What is the diagnosis?
A. Pancreatic Pseudocyst
B. Pancreatic Abscess
C. Walled off pancreatic necrosis

The most common cause of nipple discharge in non-lactating women is?

A. Prolactinoma
B. Hypothyroidism
C. Breast cancer
D. Fibrocystic disease with ductal ectasia
E. Intraductal papilloma

40 years old female with 12-year history of varicosities, complaining of left limb edema and heaviness
when standing. distal pulses are intact and there is bilateral varicose in the great saphenous vein territory.
What is your management?
A. Sclerotherapy
B. Endovenous laser
C. Thermal ablation

Morbidly obese man with hiatal hernia and procedure?

A. Ring
B. Sleeve gastrectomy
C. Roux en Y gastric bypass
 D. Balloon

Old age patient present with fresh blood per rectum, you did rectal examination and your finger full of
blood, but anorectal colonoscopy was normal. CBC was: Hb 8. What is the investigation that has a high
diagnostic value?
A. Upper GI endoscopy
B. Tch 99
C. CT
D. US

Patient elderly with central abdominal pain CT show small bowel cancer 3*4 cm with calcification, what
type of cancer?
A. Schwannoma
B. Carcinoma
C. Lymphoma

Patient with dysuria and cloudy urine with bubbling for 2 months, he had history of recurrent left iliac
fossa pain for the past 2 years, Colonoscopy done and showed: no diverticulosis or polyp, Cystoscopy
done and showed: erythema on the dome of the bladder. Most likely diagnosis is?
A. Diverticular diseases
B. Squamous cell bladder cancer
C. Transitional cell bladder cancer

50 years old with Ischemic Heart Disease (IHD), Diabetes mellitus (DM) Admitted to ICU with
severe pneumonia and was treated with Antibiotics. After 3 days of admission, he developed
hypotension and treated with hydration and inotrope, on admission lab was normal After 3 days,
LFT was abnormal Total Bili is 20 (increased), very high AST and ALT (1000), mild increase in
LDH, US done and showed unremarkable findings, what is the diagnosis?
A. Ischemic hepatitis
B. Intravascular hemolysis
C. ICU related jaundice
D. Acalculous cholecystitis

Healthy patient presenting with dysphagia with no family history of esophageal cancer, asking about the
strongest risk factor for esophageal cancer?
A. Esophageal stricture.
B. Barrett's esophagus.
C. GERD.
D. Smoking.

Patient presented with jaundice, US shows a shrunken gallbladder with dilatation of intrahepatic ducts.
What is the most likely diagnosis?
A. Acute cholecystitis
B. Gall bladder stone
C. CBD stone
D. Klatskin tumor
Patient with medial leg ulcer, what is the highest risk factor?
A. DM
B. Age
C. Pulmonary Hypertension
D. Buerger disease
E. Venous Hypertension

After resection of a pedunculated polyp the results was benign adenoma and patient has no family history
of colon cancer what to advice for reduction of colon cancer?
A. Prophylactic sigmoidectomy
B. Prophylactic colectomy
C. Annual colonoscopy
D. Lifestyle modification (healthy diet and exercise)

Patient came 3 days after Roux-En-Y surgery complaining of fever, chills and left shoulder pain. Best
diagnostic investigation is?
A. CT with contrast
B. Endoscopy
C. Laparoscopy
D. D Exploratory laparotomy
Diabetic patient with pseudo hyperepithelialization in situ, what should we do?
A. Amputate toe
B. Ulcer debridement
C. Follow up
D. Repeat biopsy

Patient who is on NSAIDS for joint pain, presented with sudden severe continuous abdominal pain. He
denied any history of vomiting, constipation, diarrhea, and or hematemesis. The pain is located in the
epigastric area with a feeling of Nausea. Upon examination. There is tenderness and rigidity, what is the
diagnosis?
A. Esophagitis
B. Acute gastritis
C. Perforated peptic ulcer
D. Boerhaave syndrome

Patient post Motor Vehicle Accident (MVA) complains of Shortness of Breath (SOB), while examining
the patient there was signs of respiratory distress and distended neck veins. Chest examination reveals
hyperresonance. What is the next step in management?
A. Needle decompression in intercostal space
B. Chest tube in intercostal space
C. Thoracotomy
D. Tube drainage in intercostal space

Patient post hernia repair, when can she get pregnant?

A. 3 months
 B. 6 months
C. 9 months
D. 12 months

Patient developed circumferential right forearm burn. O2 sat in right digit is 86% (I remember if
they mentioned anything about the pulse) What is the appropriate action?
A. Bedside escharotomy
B. Measure intra-compartmental pressure

What differentiates between chronic or acute ischemic limb (they were talking about right leg History)?
A. A-History of intermittent claudication
B. Pulseless left leg

Case of pancreatic pseudocyst, one is 18 cm x 24 cm or 17 cm how to manage?

A- Percutaneous drainage
B- Endoscopic drainage
C- Surgical drainage
70 years old male on Mechanical ventilation (MV) admitted to the ICU due to intracranial hemorrhage, 7
days later he developed ground coffee vomitus. What is the diagnosis?
A. Stress gastritis
B. Helicobacter Pylori gastritis
C. Dyspepsia

Lactating mother with a 5 cm breast mass with thinning of the skin and tender, what is the management?
A. Incision and drainage
B. Conservative with antibiotics

A patient underwent sigmoidoscopy found sigmoid lesion, histology report: Sigmoid Adenocarcinoma
with free margin with no invasion to mucosa. What is the next step?
A. Abdominal CT scan
B. Sigmoidectomy
C. Pelvic MRI
D. PET scan

45 years old patient, has a mass 5 cm in right upper limb, MRI shows a mass from triceps, what to do
next?
A. Incisional biopsy
B. Excisional biopsy
C. Core needle biopsy
D. PET scan

Adult with Hypertension and DM has 2 months history of Small perianal painful swelling, His Blood
Pressure (BP) is: 160/100?
A. Preanal abscess
 B. Preanal fistula
C. Thrombosed pile
62 years old male with Benign Prostatic Hyperplasia (BPH), His BMI: 41, what is the risk of
BPH in this case?
A. Age
B. Obesity
Patient with History of pancreatitis months ago, now referred to surgery clinic for mild abdominal pain
what is the initial investigation?
A. US
B. CT
C. Endoscopy

Patient post thyroidectomy presents with respiratory distress and an expanding mass. How will you
manage this patient?
A. Surgical exploration
B. Give Beta Blocker
C. Remove sutures in the ward

Patient presents with a scalp laceration which occurred 6 hours ago. How will you repair this injury?
A. Healing by granulation
B. Debridement with primary closure
C. Vacuum assisted closure (VAC)
D. Debridement with secondary graft
Patient with penetrating chest trauma was stable, after 45 mins he developed hypotension, thready weak
pulse and raised JVP, chest clear bilaterally, what is the diagnosis?
A. Pneumothorax
B. Pulmonary contusion
C. Pericardial tamponed

An elderly patient in ICU has bed sores with exposed necrotic skin and subcutaneous tissue. What is your
management?
A. Debridement with a skin graft
B. Debridement with assisted vacuum
C. Debridement with primary closure
D. Debridement & Dressing with secondary closure

Patient thought to have appendicitis and did appendectomy, pathology lab shower carcinoid tumor 1 cm,
what to do additionally?
A. Follow up
B. Chemotherapy
C. Radiation
D. Right hemicolectomy

Patient undergoes esophageal dilation for achalasia came after (6 or 12 hours) with chest pain,
subcutaneous crepitus and labs showed WBC 21000, what is your management?
 A. Total Parenteral Nutrition (TPN)
B. Nasogastric Tube (NGT)
C. Stent
D. Drainage and surgery
Patient presented with neck swelling, she is completely asymptomatic, neck US was done reveal a solid
mass of 7 mm with regular margins, which of the following is the most appropriate next step?
A. FNA
B. Thyroid scintigraphy
C. Check TSH

Case of Abdominal Aortic Aneurism (AAA) and the patient is hemodynamic unstable, present after he ate
food with severe abdominal pain despite taking analgesic. He became confused and unconscious later in
the hospital. Examination revealed: Tender and pulsatile mass in the abdomen, BP low. What is your
most appropriate management?
A. US
B. CT
C. Exploratory Laparotomy

47-year-old female presents with iron deficiency anemia. She has 3rd degree hemorrhoids. Which of the
following is the most appropriate thing to do?
A. Colonoscopy
B. Hemorrhoidectomy
C. CT scan

Patient underwent lap chole for multiple gallstones 7 days ago, presents with vague abdominal pain. On
US there is fluid around the gallbladder (something like that) and the CBD is 9 mm. What is the most
likely diagnosis or cause?
A. CBD injury
B. Retained stone in CBD
C. Sub-hepatic collection

Old male patient did total thyroidectomy then he developed swelling in the neck with inspiratory stridor
and SOB, how you will manage?
A. Thoracotomy
B. Surgical exploration
C. Drainage
D. Surgical evacuation

Patient did upper endoscopy and there is squamous carcinoma, which of the following is a risk factor of
esophageal cancer?
A. GERD
B.
C. Esophageal stricture
D. Smoking
25 years old man history of laparoscopic appendectomy 10 years ago, present to ER with sudden
abdominal pain and vomiting, mild generalized tender, vitally stable, abdomen X-Ray shows multiple air
fluid level and dilated loop in certain point, what is next step in management?
A. Diagnostic laparoscopy
B. Laparotomy
C. CT abdomen
D. Barium swallow

Patient with rectal bleeding 5 and 7 o clock, sclerotherapy done, what type of hemorrhoid treated?
A. Internal
B. External
C. Prolapse
D. Thrombosed

Patient presented with dysphagia to liquids more than solid, which is the most appropriate initial
investigation:
A. Endoscopy
B. Barium swallow
C. US
D. Biopsy
24 years old male medically and surgically free, presented with manifestation of intestinal obstruction,
suspected to be small bowl obstruction, what is the most common cause?
A. Hernia
B. Adhesion
C.
D. Malignancy

Young male baby came to well-baby clinic, upon examination his right testis was palpable in the inguinal
canal and small in size and easily moved to scrotum, the left is normal, what is the cause?
A. Ectopic testis
B. Undescended testis
C. Testicular torsion
D. Retractile testis

What type of polyp with highest risk of cancer?

A. Villous
B. Tubular
C. Tubulovillous
90-Year-old man with multiple comorbidities presented with many cancers in stomach, lung and colon
but the original site of the
A. Resection of tumors
B. Palliative chemotherapy
C. Comfort care
12-year-old boy injured with supracondylar fracture and distal radial pulse absent, which of the following
is the appropriate next step in management?
A. K wire
 B. Intramedullary nail
C. Surgical exploration
D. Closed reduction

A 65-year-old male comes to the clinic with a mild intermittent urinary flow reduction Rectal
examination, urinalysis and prostate specific antigen studies are normal (see report). Ultrasound prostate:
Enlarged median lobe. Which of the following is the best way to investigate?
A. Annual renal function monitoring
B. Periodic PSA measurement
C. Beta-blocker therapy
D. Cystoscopy

28 years old female came to the clinic complaining of on and off painless rectal bleeding, she had anal
swelling that reduced spontaneously, Anoscopy showed hemorrhoids on 3,7,11 o'clock with active
bleeding. Labs showed anemia, Hemoglobin was 8.8, what is the most appropriate management?
A. Follow up
B. Conservative treatment
C. Rubber band ligation
D. Hemorrhoidectomy

Old patient underwent rectal surgery then developed Deep Venous Thrombosis (DVT), what is the
management?
A. Enoxaparin
B. Heparin
C. Warfarin
D. IVC

27-year-old obese woman presents with right iliac fossa pain associated with anorexia, nausea, and
vomiting. On examination, there is moderate right iliac fossa tenderness. Labs showed: leukocytosis, what
is the most appropriate management?
A. Open surgery
B. CT
C. US
D. Diagnostic laparoscopy

Elderly patient with small lung nodule (<8 mm), he is asymptomatic, not smoker, no family history of
cancer, no constitutional symptoms, your next step is?
A. Follow up with CT scan
B. Biopsy
C. Chemotherapy
An old male patient was admitted as a case of large intestinal obstruction. He underwent rigid
sigmoidoscopy that showed a mass in the sigmoid region. A biopsy was taken and came back as
adenocarcinoma. What is the best next step?
A. Colonoscopy
B. CT abdomen
C. MRI pelvis
D. Sigmoidectomy
56 years old woman presents to the clinic with a non-healing ulcer over her right lateral malleolus, she is
hypertensive. pulse is normal and her local exam shows dark discoloration of the skin around the ulcer
and viable ulcer bed, best next step is?
A. CT angiogram
B. Venous duplex US
C. Arterial doppler US
D. Conventional angiograph

45 years old patient, came with history reducible hernia in inguinal area it pop out every two days with
mild pain and he can manuel reducible it by his finger, then he suddenly developed severe constant pain
in early morning in that area and came to hospital, on examination of the inguinal area and scrotum
examination and he is free from both them and pain is disappear, Now just have persistent nausea and
vomiting, what is the next step ?
A. Pelvic and Abdomen CT
B. Hernia repair today after 2-hour
C. Reassurance and discharger
D. Hernia repair after 2 days

Patient with chronic limb ischemia, presented with sudden leg pain, diminished popliteal and distal pulses
in right leg, and diminished distal pulse with intact popliteal in the left, what's the appropriate next action?
A. Heparin
B. CT Angiogram
C. US
D. Conventional Angiograph

Patient present to ER after RTA with SOB, on examination the tracheal shifted to the left side, in chest X-
ray, the lungs are expanded and winded mediastinum. What is the diagnosis?
A. Tension pneumothorax
B. Cardiac tamponade
C. Plural effusion
D. Raptured esophageal
Patient with epilepsy, Most common shoulder dislocation?
A. Inferior
B. Supraacronym
C. Posterior
D. Anterior

Patient post RTA with massive bleeding in the nose and mouth with leg fracture, decrease BP, patient can
take his breath, but he is afraid from what happened. What is the next step?
A. Intubate with stretching cervix
B. Packing nasal bleeding
C. IV fluid
14 years old female with epigastric abdominal pain since a month was complaining that it is affecting her
life, on exam patient had multiple bruises in abdomen when asked about it, she said it appeared after she
fell over her cycle 18 days back, next investigation is?
A. CT abdominal
B. Abdominal US
C. Laparotomy

Patient had polyps excised from his sigmoid colon and on histopathological report there was cancerous
cells with free tissue margins, Next step is?
A. Follow up
B. Sigmoidoscopy
C. Sigmoidectomy

5 years old boy with one testicle which undescended, what is your management?
A. Orchidectomy
B. Orchidopexy
C. Wait till puberty

Breastfeeding mother found unilateral mass on the lower outer quadrant of right breast (I think 3x3 cm) it
was erythematous and hot on palpation. Mildly tender. Most appropriate management?
A. Chemotherapy
B. Radiation therapy
C. Needle core biopsy
D. Aspiration and Antibiotics
GCS Question (confused, open to sound, localized pain)?
A. Minimal
B. Mild
C. Moderate
D. Severe
RTA patient came with deformed leg swelling, there is pain and paresthesia and absent pulse Most
appropriate management is?
A. Fasciotomy
B. Reduction of fracture
A child has scrotal pain, on exploration the cord was edematous and inflamed with red right hemi-
scrotum, what is the diagnosis?
A. Testicular torsion
B. Inguinal hernia
C. Testicular appendages torsion
D. Epididymoorchitis

Neck penetrating injury on zone 1 with emphysema, next step?

A. Neck exploration
B. CTA
C. Angio embolization

Child after RTA, have weak peripheral pulse, BP 70/40, Next step?
 A. Oropharynx tube
B. Endotracheal tube
C. Nasogastric tube

Patient diagnosed with UC when to be screened for cancer?

A. Annually till age of 50
B. If there is mild inflammation
C. At time of diagnosis
D. 8-10 years after diagnosis

35-year-old lady presents with a left nipple bloody discharge, by imaging it was suggestive of Intraductal
papilloma. What to do next?
A. Central Duct excision
B. Observation
C. Mastectomy
D. image guided biopsy

Case of cholangitis: what is the best imaging?

A. Serial X-ray
B. US
C. MRCP

38 years old male complain of constipation for 2 days painful perianal with positive crack on 6 & 12
clock, what is the diagnosis?
A. Anal fissure
B. Perianal abscess

30 years old patient has hyperthyroidism, taking anti thyroid drugs, she presents with exophthalmos, US
showed nodule in right lobe 2*2, nuclear study showed diffuse uptake, the diagnosis is toxic nodular
thyroid. What is the most appropriate management?
A. Right hemithyroidectomy
B. Subtotal thyroidectomy
C. Near total thyroidectomy
D. Radioiodine ablation

Patient had unilateral testicular painful swelling for 1 day, on exploration red scrotum viable but cord
edematous, what is the diagnosis?
A. Testicular Torsion
B. Incarcerated inguinal hernia
C. Appendicular torsion

Obese female patient diabetic and hypertensive, started on lifestyle modification for weight reduction but
she failed, her height: 173 cm, Weight: 126 kg, what is the most appropriate intervention?
A. Bariatric surgery
B. Weight loss medication
 C. Continue lifestyle

Child presents with hip and groin pain, US done and revealed hip joint effusion. He is febrile. What is the
most likely diagnosis?
A. Toxic synovitis
B. Benign acute childhood myositis

65-year-old female with asymptomatic femoral hernia. What is the most appropriate management?
A. Laparoscopic repair and mesh
B. Laparoscopic repair
C. Open hernia repair and mesh
D. Observation

Patient with Hip Fracture underwent Hip fixation repair surgery. What anticoagulant to give to prevent
DVT?
A. Enoxaparin Subcutaneous (SC) 40 mg daily
B. Heparin 1000 units BID

Patient with Cushing Syndrome with proven Right Adrenal Adenoma on MRI for resection, what is the
peri operative management?
A. Hydrocortisone
B. Fludrocortisone

56-year-old patient presents with left lower quadrant pain and change in bowel motion. Upon
examination, patient has fever and left lower quadrant tenderness, Imaging showed thickened bowel.
What is the diagnosis?
A. Diverticulitis
B. Sigmoid mass
C. Ruptured ovarian cyst
D. Pyelonephritis

Patient was extubated after thyroid surgery and immediately developed shortness of breath and
respiratory distress; Examination reveals that both vocal cords are in a semi-closed position. How will
you secure the airway?
A. Re intubate the patient
B. Tracheostomy tube
C. Cricothyroidotomy

Patient with Cholelithiasis and the Common Bile Duct measure 12 mm, what to do?
A. ERCP
B. MRCP
C. Cholecystectomy

Young male patient was rescued from a burning building, when he arrived at the hospital, he was fine
apart from mild drowsiness and had singed facial and nasal h
 A. Elective intubation
B. ICU admissions and Observation
C. Discharge

Female patient with 11*12 breast mass, examinations showed no palpable Lymph Node (LN). Core
biopsy done
A. Wide local excision (WLE)
A. PET scan
B. Chest CT without contrast
C. Simple Mastectomy

Patient presented to the ER with Right thigh swelling and hotness, past medical history reveled that the
patient had Atrial Fibrillation, what is the best definitive management?
A. Femoral embolectomy
B. Thrombolysis
C. Surgical exploration

Old patient presented to the hospital with jaundice, change in stool color and urine color, US showed:
multiple intrahepatic duct dilation, common bile duct dilation and very large gallbladder, what is the
diagnosis?
A. Klatskin tumor
B. CBD stones
C. Pancreatic cancer
D. Acute cholecystitis

Patient underwent left lower parathyroidectomy for primary hyperparathyroidism (adenoma). He

presented 4 months later with depressed mood and fatigability. Both parathyroid hormone and calcium
were high, what is the most common cause?
A. Parathyroid hyperplasia
B. Missed adenoma
C. New adenoma
D. Parathyroid cancer

Young male patient did hemorrhoids operation 12 Months ago, currently he complains of sever anal pain
that interfere with defecation, digital rectal exam (DRE) did not complete due to severe pain, what is the
diagnosis?
A. Fissure
B. Thrombosed hemorrhoid
C. Intersphincteric abscess

Patient smoker and obese, did US and reveled incidental 4x4 cm hepatic hemangioma. What is the most
important thing to advise the patient?
A. Decrease high carbohydrate and fatty meals
B. Stop smoking
C. Eat diet rich in fiber
D. Avoid excessive sport
Trauma patient with multiple injury to axilla and lateral chest wall, fracture 4th,5th ribs, while examination
suction sound was sourced from lacerated wound on fractured ribs (no vital data given), next step?
A. Chest tube
B. Intubation
C. Urgent Thoracotomy

70 years old with HTN and Cardiac Disease, complain of claudication after walking 100 yards in left
lower limb, while examine the peripheral pulse you noticed that the inferior popliteal pulse is weak,
dorsalis pedis not felt, next step?
A. Vascular Doppler
B. Embolectomy
C. Conventional angiography

Healthy patient done a routine checkup, imaging reveled a polyp in the gall bladder measuring 0.6 cm,
what's next step?
A. ERCP
B. Surgical consultant
C. Liver function
D. Urgent cholecystectomy

Patient diagnosed with acute pancreatitis 3 weeks ago, now present to ER Complain of mild abdominal
pain and tenderness, US showed cyst measure 4 cm, how you will manage?
A. Observation
B. Internal drainage
C. External drainage
D. Surgical remove

Male patient came to ER with right femur shaft fracture, Hemodynamically stable, no other injuries. what
is your priority?
A. Pain management
B. Blood control
C. Maintaining function
D. Decrease soft tissue trauma

Female doing annual mammography screening, this time it showed BIRAD-0 and areas of overlapping
densities in both breast, what to do?
A. Do a mammogram after 6 months
B. Continue annual mammogram

Case of Breast mass denoting carcinoma from its featured with infiltrations to skin and palpable LN
imaging done. What to do now?
A. Excisional biopsy
B. Core needle biopsy
C. FNA
Patient with thyroid mass measuring 2*3 on one lobe, patient is asymptomatic, TSH and T4 are normal,
next step in management?
A. Hemithyroidectomy
B. Nodule excision
C. Total thyroidectomy

3-year-old patient came due to 10 cm, hard, immobile mass on the lateral neck area. Aspiration revealed
lymphatic fluid. what is the next step on management?
A. Chemotherapy
B. Radiotherapy
C. Surgical intervention
D. Sclerotherapy

18 months child with left Undescended testes not palpable in the inguinal region,
the most appropriate to do?
A. Left orchidopexy
B. Diagnostic laparoscopy
C. Wait till 3 years

30 years old male had open hernia repair few years ago, presenting now with reducible inguinal hernia on
one side extending to hemiscrotum. what is the appropriate thing to now?
A. Laparotomy repair with mesh
B. Open repair
C. CT abdomen
D. US

Patient with neck injury at zone 3, Hemodynamically stable, what is the management?
A. Open exploration
B. Endovascular Intervention.

Patient with a scenario of having Crohn's disease based on imaging, presented now with fever, abdominal
pain in right iliac fossa tenderness, hemodynamically stable, CT Abdomen showed retrocecal collection
next?
A. Exploratory laparotomy
B. Percutaneous drainage

Patient had an episode of Calculus cholecystitis recovered from the attack now in hospital and asking
next?
A. ERCP
B. delayed Cholecystectomy
C. Discharge

A woman with a left breast mass for 9 months. Mammogram showed: speculated mass with suspicious
microcalcification and axillary lymph node involvement, BI-RAD V (probable malignancy), next step?
A. Excisional biopsy
 B. Core Biopsy
C. Modified radical mastectomy

Female patient presented with nausea and vomiting with suprapubic and left iliac fossa pain and
tenderness, Pregnancy test was negative, urine dipstick normal, Normal WBC counts, what is initial
management?
A. Abdominal X-Ray
B. Abdominal CT
C. Diagnostic laparoscopy
D. Analgesia & Discharge

48 years old female with diffuse goiter, labs showed high T4 low TSH, US showed bilateral thyroid
nodules, right 3x4 in size, left is 1x2 size, what to do?
A. FNA both
B. FNA the larger one
C. Total thyroidectomy

12 years old girl came with abdominal pain with Nausea and Vomiting, she had history of falling from
bike one week ago, on examination she bruises over abdomen, what next to do?
A. US
B. CT

47-year-old Patient with neck enlargement, ultrasound revealed a mass on the right side with 2*1 cm and
another mass 3*2 on the left side, where should the FNA be taken from?

A. From the left nodule.

B. From the largest nodule.
C. From both nodules.
D. From right nodule.

17 years old male with history of right iliac fossa pain rebound tenderness and positive guarding, what is
the investigation next:
A. Laparoscopy
B. US
C. CT scan

Patient post thyroidectomy developed aspiration and hoarseness, which nerve injured?
A. Superior laryngeal nerve
B. Recurrent laryngeal nerve

Trauma patient with hypotension, X-Ray reveled: Trachea shifted to the right, expanded lungs and
widened mediastinum. What is the diagnosis?
A. Massive hemothorax
B. Pneumothorax
C. Thoracic aorta rupture
D. Spontaneous pneumothorax
35 years old female her father has colon cancer when he was 55 and her mom had breast cancer when she
was 43, asking about screening?
A. She should do mammogram annually
B. Start mammogram at 40
C. Start mammogram at 40 and colonoscopy at 55
D. Colonoscopy at 50

Long history of a healthy patient presenting with dysphagia with no family history of esophageal cancer,
asking about the strongest risk factor for esophageal cancer?
A. Esophageal stricture.
B. Barrett's esophagus.
C. GERD.
D. Smoking.

Patient with hot thyroid nodule measuring 3x3 cm was removed by thyroid lobectomy. Histopathology
showed 8mm papillary carcinoma. What is the most appropriate management?
A. Completion thyroidectomy
B. Follow up 3 months
C. RAI
D. Chemotherapy

Patient had RTA with high speed 130 Km/h wearing seat belt. What initially will you do?
A. Ultrasound abdomen
B. CT abdomen
C. Abdomen X-Ray

Patient with chronic limb ischemia, presented with sudden leg pain, diminished popliteal and distal pulses
in right leg, and diminished distal pulse with intact popliteal in the left, what's the appropriate next action?
A. Heparin
B. CT angiogram
C. US
D. Conventional angiograph

Patient develop surgical emphysema neck chest abdomen after ERCP, which organ was injured or
perforated?
A. Esophagus
B. Stomach
C. Pancreas
D. Duodenum