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1. Concerning lingual ectopic thyroid in a young girl, the incorrect statement is that it: a.
Is a congenital lesion.
b. Is usually located behind the foramen caecum at the back of the tongue. c. Is best diagnosed by thyroid scan. d. Requires needle biopsy for confirmation e. Often responds to thyroxine.
2. In physiological goiter, the following statements are true except that it: a. Presents as fullness of the neck (Venus neck). b. Is characterized by uniform smooth enlargement with fleshy or firm consistency. c. May be associated with toxic or pressure symptoms. d. Usually resolves spontaneously.
3. The following statements about colloid goiter are true except that it : a. Is rare except in endemic areas. b. Usually occurs in the ages between 20 and 40 years. c. Causes a large disfiguring cervical swelling. d. Usually resolves spontaneously. e. Requires treatment by partial thyroidectomy.
4. The best routine treatment for multinodular goiter is by: a. Hemithyroidectomy. b. Partial thyroidectomy. c. Bilateral wedge resection. d. Subtotal thyroidectomy. e. Thyroxine administration.
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5. Among the following statements about retrosternal goiter, the false one is that it: a. Usually rises in aberrant intra-thoracic thyroid tissue. b. Is particularly common in males. c. May be present with symptoms of mediastinal compression (syndrome). d. Is often associated with palpable enlargement of the thyroid gland. e. Is best removed through a cervical incision.
6. A middle-aged female presented with an asymptomatic nodule in the right lobe of thyroid. She gave a history of irradiation in childhood. The nodule was cold on radioiodine scanning and the sonogram revealed that it was a solid mass. The appropriate management at this stage is: a. Aspiration biopsy. b. Treatment with thyroxine. c. Right lobectomy. d. Subtotal thyroidectomy. e. Total thyroidectomy.
7. Voice fatigue after thyroidectomy is due to injury of which of the following nerves? a. Superior laryngeal. b. External laryngeal. c. Internal laryngeal. d. Recurrent laryngeal. e. Vagus. 8. Medical treatment in thyrotoxicosis is least useful in: a. Cases with true exophthalmos. b. Pregnant females. c. Secondary thyrotoxicosis. d. Uncomplicated thyrocardiac patients. e. Post-operative recurrence.
9. Thyrotoxicosis during pregnancy is best treated with: a. Subtotal thyroidectomy. 2 MedadTeam
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b. Carbimazole. c. Beta blockers. d. Lugol's iodine. e. Radioiodine. 10. Primary thyrotoxicosis is characterized by the following except: a. Loss of appetite. b. Loss of weight. c. Emotional instability. d. Intolerance to heat. e. Excessive sweating. 11. The following statements about treatment of thyrotoxicosis by radioactive iodine are true except that it: a. Is contraindicated in patients below the age of 40. b. Is particularly useful in elderly and thyrocardiac patients. c. Produces its beneficial effects within a few days. d. May be followed by myxoedema. e. Carries the risk of late occurrence of thyroid cancer. 12. The most serious complication of subtotal thyroidectomy for thyrotoxicosis is: a. Post operative thyroid crisis. b. Injury to the recurrent laryngeal nerve. c. Hypothyroidism. d. Recurrence of thyrotoxic symptoms. e. Hypoparathyroidism. 13. Three hours after subtotal thyroidectomy for throtoxicosis, an elderly female developed delirium with high fever and tachycardia. The appropriate management includes the following except: a. IV glucose-saline with lugol's iodine. b. Dopamine. c. Propranolol (inderal). d. Chlorpromazine. e. Hydrocotisone. 3 MedadTeam
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14. Hypothyroidism is most often due to: a. Multinodular goiter. b. Solitary adenoma. c. Thyroid cancer. d. Chronic thyroiditis. e. Iatrogenic causes. 15. As regard embryology of thyroid: a. Develops from 1st branchial arch. b. Develops from 4th branchial arch. c. Both a & b. d. None of the above. 16. C-cells of the thyroid gland: a. Develop from altimobranchial body. b. Produce calcitonin. c. Are the origins of medullary carcinoma. d. All of the above. 17. As regards to T3: a. Less concentration than circulating T4. b. More potent than T4. c. Mostly bound to TBG. d. All of the above. 18. The correct sequence of events for the metabolism of iodine & synthesis of thyroid hormones: a. Trapping, organification, coupling, release, oxidation. b. Oxidation, trapping, coupling, organification, release. c. Coupling, organificstion, trapping, oxidation, release. d. Trapping, coupling, oxidation, release, organification. e. Trapping, oxidation, organification, coupling, release. 19. a. b. c. d. e.
The daily requirement of iodine is: 60-70 ugs. 80-90 ugs. 100-125 ugs. 50-165 ugs. None of the above.
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20. The most diagnostic single investigation for toxic adenoma is: a. T3-T4. b. US. c. Thyroid scan. d. FNABC. 21. The following statements regarding TSH measuring are true except: a. It's increased after total thyroidectomy. b. Normal TSH is about 5 micro units / liter. c. It's the most sensitive test for mild cases. d. All of the above. 22. a. b. c. d.
Warm nodule means: Inactive nodule. Usually cancerous. Active nodule. Toxic adenoma.
23. a. b. c. d.
As regard FNABC all correct except: Outpatient procedure. Cheap & safe. Requires general anaesthesia. Can't differentiate follicular adenoma from carcinoma.
24. a. b. c. d.
Presentations of ectopic thyroid include: Dysartheria. Midline neck swelling. Myxedema if removed by mistake. Any of the above.
25. The most common site of thyroglossal cyst is: a. Subhyoid. b. Suprahyoid. c. Sublingual. d. At thyroid cartilage. 26. The following are true about thyroglossal cyst except: a. Usually presents as a midline neck swelling. b. May be confused with ectopic thyroid. c. Best treatment is follow up. 5 MedadTeam
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d. Should be excised completely for fear of complications. 27. Preparation of retrosternal goiter for surgery include: a. Neomercazole. b. Lugol’s iodine. c. Propranolol. d. A & C. 28. Autoimmune manifestations of grave's disease include the following except: a. Palmar erythema. b. Clupping. c. Pretibial myxedema. d. Exophthalmos. 29. All of the following are recognized complications of neomercazole except: a. Goiter. b. Agranulocytosis. c. Renal failure. d. Hepatotoxicity. 30. Thyrotoxicosis in children all are correct except: a. Usually goes into spontaneous remission. b. Medical treatment alone can control the disease. c. Radioactive iodine is the ideal treatment. 31. Which of the following treatment schedule for diffuse toxic goiter is true: a. Over 45 years: radioactive iodine. b. Under 45 years: with large goiter: surgery. c. Under 45 years: with small goiter: anti-thyroid drugs. d. None of the above. e. All of the above. 32. Toxic goiter has the following sign except: a. Flapping tremors of the hand. b. Exophthalmous. c. Diarrhea. d. Menstrual irregularities.
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33. 3 hours post-thyroidectomy a 30 years old woman developed agitations, difficulty breathing, tachycardia & dry dressing but anterior cervical swelling. The most appropriate immediate step is: a. Insertion of an oro-tracheal tube. b. Reopening of the cervical wound. c. Estimation of serum calcium level. d. IV morphine. 34. On the 5th postoperative day after total thyroidectomy, a patient complains of tingling of the fingertips & the serum calcium level of 5.5 mg/dl the next step should be : a. Observation only. b. Administration of vitamin D2 or D3 50000-100000 units/day. c. Administration of vitamin D3 1-2 ug/day. d. Administration of calcium gluconate 3-6 g /day .by slow IV drip. 35. The term lateral aberrant thyroid really implies : a. Congenital aberrant thyroid tissue lateral to thyroid. b. A metastasis in a cervical lymph node from an occult thyroid carcinoma. c. A metastasis from carcinoma of the larynx. d. A type of branchial cyst. e. That a loose piece of thyroid has become implanted in thyroidectomy scar. 36. Hoarseness of voice denotes: a. Compression of the superior laryngeal nerve. b. Infiltration of the recurrent laryngeal nerve. c. Infiltration of the superior laryngeal nerve. d. Tracheal compression. 37. Recurrent goiter may be due to: a. Inadequate initial removal. b. Persistence of aeitiology. c. Foreign body reaction. d. Any of the above. 38.
Excision of thyroglossal cyst should include removal of: a. Thyroid isthmus. b. Pyramidal lobe. c. Body of the hyoid bone. d. Foramen caecum.
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Answers
1–D a lingual thyroid is a congenital lesion due to failure of the thyroglossal tract to descend from its point of origin at the foramen caecum. Diagnosis is by thyroid scan which reveals absence of thyroid tissue in its usual location. Needle biopsy is contraindicated because it may result in bleeding and enlargement of the swelling. Treatment is by thyroid hormone suppression which usually obviates the need for operation. 2- C Apart from cervical swelling, physiological goitre is symptomless. 3- D Colloid goitre tends to turn toxic or nodular and never resolves spontaneously. 4- D The treatment of multinodular goitre is surgical by thyroidectomy. Even in unilateral cases, subtotal thyroidectomy is superior to the other methods which are often followed by recurrence from growth of tiny adenomata in the remaining gland. 5–A Retrosternal goiter rarely arises in aberrant intra-thoracic thyroid tissue and usually it starts in a normal thyroid as a nodular goitre which descends into the mediastinum under the influence of gravity and the negative intra-thoracic pressure. 6–C Solitary solid nodule will be malignant in 30% of cases and require lobectomy for diagnosis. In this case, the history of previous irradiation and failure of radioiodine uptake by the nodule are more suggestive of malignancy. Further management will depend on the type of malignancy. 7–B The external laryngeal nerve may be injured during high ligation of the superior pole due to its close proximity of the superior thyroid vessels. This causes paralysis of the cricothyroid muscle resulting in a low-pitched voice and voice fatigue which recover in a 8 MedadTeam
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few months. In contrast, unilateral injury to the recurrent laryngeal nerve causes immobility of the corresponding vocal cord and the difference in tension of two cords leads to permanent hoarseness of voice. Injury to the other nerves is rare and results in more serious symptoms. 8-C in 2ry thyrotoxicosis the anti-thyroid drugs and radioiodine are ineffective and thyroidectomy is the only method of cure. 9–B In pregnancy, carbimazole treatment is effective but to avoid the danger of producing hypothyroid babies, the smallest dose is given supplemented by propranolol and substituted during the last 4 weeks by lugol's iodine. Since the drug is secreted in the milk, it is necessary either to wean the child or to resort to thyroidectomy. 10 – A Due to the raised metabolic rate in 1ry thyrotoxicosis, there is loss of weight despite an increased appetite. 11– C Under radioiodine treatment (4-8 cm), the toxic symptoms subside within 2-3 months. If after the third month toxic symptoms present a smaller dose (2-4 cm) may be given 12- B 13- B 14- E 15-
C
16-
D
17-
D
18-
E
19-
C
20-
C
21-
B
22-
C
23-
C
24-
D
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Note Name 25-
A
26-
C
27-
C
28-
A
29-
C
30-
C
31-
E
32-
A
33-
B
34-
D
35-
B
36-
NMT13
B
37- D 38- C
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NMT13
The commonest complicated hernia is : a. Femoral. b. Inguinal. c. Lumbar. d. Epigastric.
2.
Subtypes of femoral hernia don`t include : a. Laugier hernia. b. Spigelian hernia. c. Cloquet hernia. d. None of the above.
3.
Exomphalos refers to : a. Congenital inguinal hernia. b. Femoral hernia. c. Congenital umbilical hernia. d. None of the above.
4.
Appendecectomy may be complicated by which type of hernia : a. Indirect inguinal hernia. b. Direct inguinal hernia. c. Femoral hernia. d. Paraumbilical hernia.
5.
The following hernia is the most liable to strangulation : a. Femoral hernia. b. Inguinal hernia. c. Umbilical hernia. d. Incisional hernia.
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NMT13
The following organ can`t herniate : a. Bladder. b. Pancreas. c. Caecum. d. All of the above.
7.
As regards clinical picture of hernia : a. Scar at site of hernia has no medical importance. b. Irreducibility predisposes to complications. c. Hernia is always painful. d. All of the above.
8.
The treatment of choice in strangulated hernia is : a. R & M. b. Urgent exploration is the rule. c. Reduction by taxis must be tried first. d. A & B.
9.
Ventral hernia is the: a. Femoral hernia. b. Inguinal hernia. c. Internal hernia. d. Incisional hernia.
10.
Direct hernia: a. Passes through the internal ring. b. Passes through the external ring. c. Usually descends to scrotum. d. Is more common than the indirect one.
11.
The structure that lies between the two components of pantaloon hernia is : a. Spermatic cord. b. Conjoint tendon. c. Femoral artery. 12 MedadTeam
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d. Inferior epigastric artery. 12.
All of the following are causes of hernia irreducibility , the commonest is : a. Omental contents. b. Adhesions. c. Overcrowding. d. Narrow neck.
13.
Sliding hernia : a. May contain part of bladder wall. b. Causes partial irreducibility. c. Predisposes to complications. d. All of the above.
14.
The most serious complication of hernia is : a. Inflammation. b. Obstruction. c. Strangulation.
15.
The differentia diagnosis of an inguinoscrotal swelling includes all of the following except : a. Oblique inguinal hernia. b. Hydrocele of hernial sac. c. Bubonocele. d. Lipoma of the cord.
16.
Concerning the anatomy of the inguinal canal , the incorrect statement is that it : a. Lies half-inch above the inguinal ligament. b. Extends from the mid inguinal point to the pubic spine. c. Transmits the spermatic cord in the male and the round ligament of uterus in females. d. Ends at the external abdominal ring close to pubic spine.
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17.
NMT13
The covering of the sac of oblique inguinal hernia do not include the : a. Skin and superficial fascia. b. Deep fascia. c. External spermatic fascia. d. Cremasteric muscle and fascia. e. Internal spermatic fascia.
18.
Hesselbach`s triangle is not bounded by : a. Rectus muscle. b. Linea semilunaris. c. Inferior epigastric artery. d. Inguinal ligament. e. Medial umbilical ligament.
19.
Concerning direct inguinal hernia , the incorrect statement is that it : a. Usually affects elderly males. b. Is often bilateral. c. Seldom descends into scrotum. d. Protrudes lateral to inferior epigastric artery. e. Rarely undergoes strangulation.
20.
True statement about paraumbilical hernia include the following except that it : a. Affects females more than males. b. Protrudes through the umbilical scar. c. Is often associated with divarication of recti. d. Is rarely completely reducible.
21.
The coverings of the sac of femoral hernia include the following except the : a. Skin. b. Superficial fascia. c. Deep fascia. 14 MedadTeam
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d. Cribriform fascia. e. Transversalis fascia and femoral septum. 22.
The sac of femoral hernia protrudes through the : a. Femoral ring. b. Femoral canal. c. Saphenous opening. d. None of the above. e. All of the above.
23.
24.
The sac of Richter`s hernia contains :
Part of circumference of a bowel loop.
Mickel`s diverticulum.
Double loop of small bowel.
Patch of omentum.
Loop of large bowel.
A 35-year-old multiparous female presented with a reducible right inguinal swelling which was diagnosed as a hernia. This hernia is most probably : a. Femoral. b. Direct inguinal. c. Indirect inguinal. d. Obturator.
25.
The structure forming a common boundary for both Hesselbach`s triangle and femoral triangle is the : a. Inferior epigastric artery. b. Linea semilunaris. c. Inguinal ligament. d. Pectineal ligament.
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Note Name 26.
NMT13
A 70-year-old male presented with chronic constipation and abdominal distension. On examination, he was found to have a longstanding large left scrotal hernia and the barium enema revealed that the hernia contained sigmoid colon. Operative exploration proved the presence of: a. Femoral hernia. b. Direct inguinal ligament. c. Indirect inguinal ligament. d. Obturator hernia. e. Sliding inguinal hernia.
27.
A 25-year-old male presented with a painful tender right inguinal hernia and colicky abdominal pain. The abdominal plain X-ray showed multiple fluid levels. The correct management is by : a. Naso-gastric suction and repeated observation. b. Glycerin enema. c. Taxis and truss treatment. d. Urgent herniotomy.
28.
A young female presented with an extremely tender right inguinal mass which could be an inguinal lymph node or strangulated femoral hernia. The best diagnostic measure is by : a. Ultra-sonography. b. Abdominal x- ray. c. Response to antibiotics. d. Aspiration biopsy. e. Operative exploration.
29.
In children and adolescence, the commonest cause of intestinal obstruction is : a. Bands and adhesions. b. Intussusceptions. c. Strangulated hernia. d. Neoplasm. e. Benign stricture.
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The factors which predispose to recurrence after repair of an oblique inguinal hernia do not include : a. Inadequate repair of the posterior wall of inguinal canal. b. Overlooking an associated direct hernia sac. c. Use of absorbable suture material. d. Inadequate approximation of the external ring. e. Poor approximation of the internal ring.
Answers 1.
B
2.
B
3.
C
4.
B
5.
A
6.
B
7.
B
8.
D
9.
D
10. B 11. D 12. B 13. D 14. C 15. C 16. D 17. B “There is no deep fascia in the anterior abdomainal wall. In the inguinal region, the superficial fascia consists of a superficial fatty layer and a deep membranous layer, the latter being popularly known as Scarpa`s fascia. “
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18. E “N.B.: the medial umbilical ligament is formed by the obliterated hypogastric artery ... It divides the Hesselbach`s triangle into medial & lateral parts “ 19. D “unlike oblique inguinal hernia , the sac of direct hernia protrudes medial to the inferior epigastric artery within Hesselbach`s triangle“ 20. B “In adults, the umbilical scar is the strongest part of the linea alba which is broader and thinner above the umbilicus than below it. The adult type of umbilical hernia usually protrudes just above the umbilicus and is, therefore, known as para-umbilical hernia. The infantile type of umbilical hernia is due to yielding of the umbilical scar itself because of rickets and raised intra-abdominal pressure from flatulence, phimosis or chronic bronchitis. 21. C “The cribriform fascia is the part of the deep fascia of the thigh (fascia lata ) overlying the saphenous opening . It is so named because it is pierced by the great saphenous inguinal lymph node giving it a sieve – like appearance “ 22. E “The sac of femoral hernia protrudes through the femoral ring and descends vertically in the femoral canal to reach the saphenous opening where it becomes s.c. and turns upwards and laterally towards the ant. Sup. iliac spine” 23. A “In Richter`s hernia, the intestinal protrusion consists of a protrusion of the bowel wall so that the lumen remains patent if obstruction or strangulation occurs. This type of herniation is most often encounted in femoral hernias “ 24. C “Although femoral hernia is more common in females , indirect inguinal hernia is the most common type in both sexes“ 25. C “The inguinal ligament separates Hesselbach`s triangle above from the femoral triangle below “ 26. E “The sigmoid colon rarely herniates within a hernia sac and usually protrudes through the hernia aperature alongside the sac of an indirect inguinal hernia. A similar herniation affects the cecum on the right side. This type of herniation is due 18 MedadTeam
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to enlargement of the peritoneal sac by drawing on the posterior parietal peritoneum covering the caecum or sigmoid, hence the term “sliding hernia “. 27.D “The clinical and radiological findings are typical of strangulated hernia which always requires urgent local operative intervention “ 28. E “If it was found to be an infected lymph node , nothing is lost while if it was strangulated hernia, gangrene, perforation and peritonitis will occur “ 29. C “In children and adolescents, strangulated hernia is the most common cause of intestinal obstruction. Combining all age groups, over 80% of all obstructions are caused by adhesive bands, strangulated hernias and neoplasms“. 30. D “The external ring is irrelevant in inguinal hernioprrhaphy “
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1. The most useful investigation for a breast with a prosthesis is : a. Mammography. b. Ultrasound. c. FNABC. d. MRI. e. Hormonal receptors. 2. Triple assessment include the following except : a. Clinical evaluation. b. Imaging. c. Laboratory investigations. d. Cytology. 3. The following is treatment of choice in pericanalicular fibroadenoma : a. Irradiation. b. Enucleation. c. Removal en block. d. Simple mastectomy. 4. A 21-year-old woman presents with an asymptomatic breast mass. Which of the following statement(s) is/are true concerning her diagnosis and treatment? a. Mammography will play an important role in diagnosing the lesion. b. Ultrasonography is often useful in the D.D. of the lesion. c. The mass should always be excised. d. The lesion should be considered pre-malignant. 5. A palpable breast mass in a woman of 40 years : a. Is most likely to be cyst or carcinoma. b. Investigations by US are 90% sensitive for malignancy. c. Mammography alone is 90% sensitive for malignancy. d. May be ductal carcinoma insitu. e. Triple as assessment (clinical H/E, Mammography/US and FNAC combination) is 90% diagnostic. 20 MedadTeam
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f. All of the above. a.
6. Soft tissue mammography is most valuable in : a. Differentiating of benign from malignant masses. b. Mass screening of women of child-bearing age. c. Detection of impalpable breast cancers. d. Clinical staging of breast cancer. e. Investigation of discharging nipples. 7. In hard fibroadenoma of female breast, it is untrue that it : a. Has a peak incidence in the second and third cascades. b. Forms a localized mobile lump. c. Is usually painless. d. May turn malignant. e. Never resolves under medical treatment.
Answers 1. D 2. C 3. D 4. B 5. F 6. C 7. D
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