General Surgery - Collection

Salivary gland

Parotid

1. What is Frey's syndrome?

2. Classify parotid tumours.
3. Surgical anatomy of the facial nerve.

Submandibular

1. Explain:
o Massive bleeding which may occur during submandibular sialo adenectomy.
o Loss of epsi-lateral sensation in the anterior 2/3 of the tongue after that
operation (rare).
o Dropped angle of the mouth also may occur post operatively. (Common)
o What nerves are at particular risk in the operation for removal of a
submandibular gland. Describe the clinical presentations if injury had been
occurred.
2. Two important nerves related to submandibular gland and clinical manifestations of their
accidental injuries during gland excision.
3. Submandibular duct stones.
4. Chronic submandibular sialadenitis.

Hernia

1. Define the following anatomical landmarks:

a) Iliopubic tract
b) Cooper ligament

2. Explain:

a) Numbness in ipsilateral thigh after inguinal hernia repair

b) Conservation is not recommended in asymptomatic oblique inguinal hernia

3. Explain and enumerate treatment:

a) Necrotic testicular tissue discharge from the scrotum after 10 days od repair of
recurrent oblique inguinal hernia
b) Elevation of serum urea and creatinine after 5 days of sliding inguinal hernia
repair

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 c) Fecal discharge sinus after 5 years of ventral hernioplasty
d) Clear fluid within infant scrotum appears at the end of the day and disappears at
the morning

4. Mention the boundaries of inguinal canal.

5. Complications of inguinal hernia. (5 marks)
6. Types of indirect (oblique) inguinal hernia.
7. Enumerate 6 differences between indirect and direct inguinal hernia.
8. Anatomical explanation of high rate of complications associated with femoral hernia.
9. Boundaries of femoral ring. (5 Marks)
10. Complications of hernia.

Breast

1. After modified radical mastectomy is performed and pathological evaluation

revealed a 3.2 cm intraductal carcinoma with 5 of 15 axillary lymph nodes positive
for metastasis. What is her tumor- Node (TN) stage?
2. Discuss. Sentinel L.N biopsy has become a standard diagnostic procedure in clinically
negative L.N breast cancer patients.
3. Explain the following morbidities which occur after modified radical mastectomy:

a) Atrophy of pectoralis major muscle.

b) Acute painful swelling of the ipsilateral arm.
c) Atrophy of latissimus dorsi muscle.
4. Enumerate three indications of MRI for evaluation of breast abnormalities.
5. Discuss diagnosis and treatment for a case of retro-areoler mass 4×5 cm in size in 43
female with palpable central axillary lymph nodes.
6. Discus the protocol of management for a female patient aged 57 years old presented
by breast lump 5cm size in upper lateral quadrant with no palpable axillary LN on
clinical examination.
7. Discuss a protocol of management for a female patient age 34 years old presented
by blood nipple discharge.
8. Discuss a protocol of management for a lactating woman aged 28 years old
presented by severe unilateral signs of inflammation with high fever and shivering.
9. Differential diagnosis of nipple discharge. (5 Marks)
10. Discuss: Management of nipple discharge.
11. Mammary Duct Ectasiaza discuss: aetiology, clinical picture and treatment.
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12. Types of fibro adenoma of the breast & Mention the clinical presentation of each.
13. Six skin signs of breast cancer.
14. BRACA is a new name in etiology of breast cancer. (Discuss)
15. Differential diagnosis of benign breast lump.
16. Differential diagnosis of hard breast lump.
17. Enumerate the four items of stage III “Manchester staging” breast cancer.
18. Enumerate: Mammographic findings of malignant breast mass.
19. Enumerate indications of breast conservative surgery.
20. Enumerate 5 contraindications of breast conservative surgery in breast cancer
21. BCS (Breast conservative Surgery) as a surgical treatment for breast cancer:
(Enumerate five considerations in determining the feasibility of BCS, Define sentinel
lymph node and assess its surgical importance & enumerate the techniques for BCS.
22. Sentinale LN: (Definition, Role in diagnosis and treatment of breast cancer).
23. Surgical options for treatment of early breast cancer. (5 Marks)
24. Treatment for a 32 years female patient with breast mass (diagnosed as cancer) 2cm
25. Management of stage II breast cancer.

Thyroid & Parathyroid

Goiter

1. Describe the algorism for management of solitary thyroid nodule

2. Female patient, 18 years old with diffuse thyroid enlargement. Discuss:
a. Pathogenesis of physiological goiter
b. Single symptom and single sign that support Grave's
c. This patient proved to have single nodule 2* 2cm in size by neck ultrasound.
How can you manage this case
d. How can you exclude Hashimoto's thyroiditis
e. If surgery is decided, enumerate specific complications of that surgery.
3. Mechanism of formation and physiologic effects of thyroid hormones (T3-T4).
4. Types of thyroiditis (enumerate).
5. Treatment of primary toxic goiter.

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6. What forms of treatment are available to a young woman with symptomatic
hyperthyroidism? Enumerate the drawbacks of medical therapy.
7. Which drugs are useful in the treatment of hyperthyroidism? What is their
mechanism of action?
8. Enumerate 5 indications of surgery in Grave's disease
9. Clinical picture of Grave's disease
10. Grave’s disease (Explain its pathogenesis, Enumerate its ocular manifestations, Four
instructions to your patient prior to medical treatment).
11. Discuss pathogenesis of Grave's disease and enumerate different options of treatment.

12. Grave’s disease is classified as auto immune disease (Explain & Enumerate different
lines of treatment)
13. Complications of simple nodular goitre. (5 Marks)
14. Explain: Skull pulsatile mass associated with neck swelling.
15. Explain: Deaf child with goitre.
16. Thyroid storm (Clinical picture, Treatment)
17. Explain: Hypo function after a transient attack of hyper function thyroid in female
patient aged 22 yrs. Enumerate single lab test to confirm the diagnosis.
18. Toxic thyroid disease.

Thyroid cancer

19. In medullary thyroid carcinoma, Enumerate:

a) Cells of origin
b) Serum tumor marker
c) Biological screening for associated lesions as known as syndromes
20. Classification of cancer thyroid.
21. Mention the main line of spread of each type of malignant thyroid.
22. Complications of thyroidectomy.
23. Enumerate nerves related to the thyroid gland and sequlae of injury of each.
24. Medullary thyroid carcinoma (Diagnosis, Treatment)
25. Explain: Hoarseness of voice loss-of high pitched voice and chocking in patient with
recent history of thyroidectomy.

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 Maxillofacial

1. In salivary gland stones. Enumerate:

a) Symptoms
b) Tests for diagnosis
c) Complications
2. Discuss differential diagnosis of oral ulcers
3. Discuss causes, clinical picture and treatment of branchial cyst
4. Differential diagnosis of jaw swellings.
5. Differential diagnosis/types of gum swellings.
6. Differential diagnosis of chronic tongue ulcers.
7. Cysts in the maxillofacial region.
8. Enumerate oral precancerous lesions
9. Enumerate different clinical presentations of cancer tongue.
10. Clinical presentation & investigation of tongue cancer.
11. Write short account on: diagnosis and treatment of cancer tongue.

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 General Surgery - MCQs
Hernia 4. A 39- year-old male has a mildly tender
irreducible lump in his right groin. Over the past
1-An 83 year-old woman presents on a Friday 18 hours he has had worsening abdominal
night complaining of a small, painful mass, low distension and vomiting, and has passed no bowel
down in her right groin, present for 24 hours and motion. Which of the following actions is MOST
associated with abdominal pain and nausea but appropriate?
no vomiting. She has opened her bowels normally a. admit to hospital for nasogastric suction,
that day. You would advise her that: intravenous fluids and observation .
a. Intravenous antibiotics are needed to treat her b. admit to hospital for nasogastric suction,
lymphadenitis. intravenous fluids, and urgent surgical review
b. She needs advice about a truss as she is too old c. refer to consultant surgeon within the next week.
for surgery d. send him home, avoid all solid food, and stay on
c. She will need an elective mesh repair of her acute oral fluids only.
direct inguinal hernia 5. You are a resident medical officer working in a
d. Surgical consultation is urgent as small bowel general surgery unit. You will be assisting with an
infarction is a risk in femoral hernia inguinal hernia repair on tomorrow's operating list
e. The cause is probably a viral illness with inguinal and you are revising your understanding of
lymphadenopathy inguinal hernial anatomy. Which of the following
2-Regarding anatomy of the inguinal canal: features is associated with a direct inguinal hernia?
a- It extends from the ASI spine to the symphysis a- Patent processus vaginalis.
pubis. b- Protrusion of the hernial contents through the
b- Begins medial to the inferior epigastric vessels. internal inguinal ring.
c- Transmits the spermatic cord to the scrotum. c- The hernial sac enters the inguinal canal medial to
d-The conjoined tendon is its lower boundary. the inferior epigastric vessels.
e- Ends at the femoral ring. d- The hernial sac may extend into the scrotum
3. 19 year-old male university student has a mildly 5. Female aged 42-year- presented to OPD. With
tender irreducible lump in his right groin. Over the intermittent painless swelling in her Rt. groin since
past 18 hours he has had worsening abdominal 2 years with no other symptoms. Examination
distension and vomiting, and has passed no bowel showed soft mass in the upper medial aspect of
motion and minimal flatus. Which of the following the thigh that disappears on compression. That
actions is MOST appropriate? mass is mostly:
a. He should be admitted to hospital for nasogastric a- direct inguinal hernia.
suction and intravenous fluids and observation until b- inguinal lymphadenopathy.
the condition settles. c- indirect inguinal hernia.
b. He should be admitted to hospital for nasogastric d- femoral hernia.
suction, intravenous fluids, and urgent surgical e- psoas abscess.
review He should be referred to consult a surgeon 6. A 5-year-old child was found to have left
within the next week. inguinal hernia and surgery was decided for
d. He should be sent urgently for a physiotherapist him.What is operation of choice?
or massage therapist to reduce the groin lump. A) Shouldice herniorrhaphy
e. He should go home, avoid all solid food, and stay B) Mesh herniorrhaphy
on oral fluids only, until the condition settles C) Herniotomy.
D) Darning

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7. In which of the following situations is 3. Mrs. fatma is a 22-year-old woman. She was
herniotomy alone the MOST suitable surgery for feeling well before 1 year. Then she gradually
inguinal hernia? develop small movable lump in her right breast.
a. In a 5 year old child with indirect hernia After 2 months; she noticed a lump in the left
b. In 28 year old female patient with indirect hernia breast too. No palpable axillary lymph nodes.
c. A 76 year old with direct hernia During the course of the disease, she neither
d. A 52 year old lady with incisional hernia suffered from fever nor had any pain in same
e. A 48 year old patient with recurrent inguinal region.What is the most probable diagnosis?
hernia a. Bilateral fibroadeomas
8. Which of the following type of hernia is more b. Fibrocystic disease of the breasts
likely to be complicated by strangulation? c. Duct papillomas d.Traumatic fat necrosis
a. Direct inguinal hernia. 4. A 32-year-old woman presents to the breast
b. Femoral hernia. clinic with a painless lump in right breast of 6-
c. Umblical hernia. month duration. On examination, she had a 10x8
d. incisional hernia. cm lump in her right breast. There were no axillary
lymph nodes. Which of the following is the most
Breast likely histopathological diagnosis in this patient?
a. Lobular carcinoma in situ.
1. Mrs. fatma is a 22-year-old woman. She was b. Invasive ductal carcinoma.
feeling well before 1 year. Then she gradually c. Ductal carcinoma in situ. d. Sarcoma of the ribs.
develop small movable lump in her right breast. e. Phylloides tumor
After 2 months; she noticed a lump in the left breast 5. Which one of the following findings in cancer
too. No palpable axillary lymph nodes. During the breast is indicative of a good prognosis?
course of the disease, she neither suffered from a. Over-expression of the HER2 proto-oncogene
fever nor had any pain in same region.What is the b. Size less than 50 mm in maximum diameter
most probable diagnosis? c. Lymph nodes are not involved
a. Bilateral fibroadenomas d. Negative estrogen and progesterone receptors
b. Fibrocystic disease of the breasts 6. A 50- year-old woman referred to the breast
c. Duct papillomas clinic with a small ulcer over her right nipple and
d. Traumatic fat necrosis areola. There is no evidence of palpable breast
2. A female 22-year-old was feeling well before 1 lumps on clinical examination. What is the next
year. She accidentally discovered a small movable step at this stage?
lump in her right breast. After 2 months; she a. Ultrasonography and core biopsy
noticed another lump in the left breast too. No b. Mammogram and core biopsy
palpable axillary lymph nodes. During the course c. Stereotactic biopsy
of the disease, she neither suffered from fever nor d. Mammogram and incisional biopsy
had any pain.What is the most probable diagnosis? 7. A 37- year- old female presented with multiple
a. Bilateral fibroadenoma masses left breast and cyclical mastalgia since the
b. Fibrocystic disease of the breasts last 4 months. Mammogram reveals generalized
c. Duct papillomas density of left breast. Ultrasound shows dense
d.Traumatic fat necrosis glandular parenchyma. No focal lesion or duct
dilatation is seen. What is the most probable
diagnosis?
a. Duct ectasia
b. Plasma cell mastitis c. Fibroadenoma

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8. A 37- year- old female presented with multiple 12. A 45 year-old woman presents to the Breast
masses left breast and cyclical mastalgia since the Clinic with breast lump size 2x3 cm. Imaging and
last 4 months. Mammogram reveals generalized FNAC confirms the diagnosis of breast cancer. The
density of left breast. Ultrasound shows dense plan is wide excision of the tumor area; conserve
glandular parenchyma. No focal lesion or duct the breast followed by radiotherapy to involve
dilatation is seen. What is the most probable field by after-loading technique. After excision of
diagnosis? the lump, decision to dissect axilla depends on the
a. Duct ectasia b. Plasma cell mastitis sentinel node which of the following is the ideal
c. Fibroadenosis d. Fibroadenoma technique of locating sentinel lymph node during
9. A 42-year-old premenopausal woman has felt surgery?
accidentally a 4 cm lump in her Rt. breast. She has a. Inspection b. Palpation
also noticed a lump in her axilla. Recently, she has c. Blue dye d- Isotope scan
resistant pain over her lumbar spine. Biopsy e- Blue dye + isotope scan
proved it to be cancer breast, what is the most 13. A 28- year-old woman presents with a three
probable stage? month history of premenstrual pain and swelling
a. Stage 1 b. Stage 2 of her breasts. On examination there is a tender
c. Stage 3 d. Stage 4 plaque-like thickening in the upper outer quadrant
10. A 61-year-old woman has an itchy nipple. This of the left breast that measures 3x4 cm. What is
persists despite application of a corticosteroid the most likely diagnosis?
cream. Her breast skin is indurated, roughened a. Ductal carcinoma. b. Fibroadenoma.
and reddish-orange. The core biopsy showed an c. Fibrocystic change. d. Fat necrosis.
invasive ductal carcinoma with malignant cells in e. Plasma cell mastitis
dermal lymphatics.Which of the following is the 14. A 51-year-old woman had noted bloody
most appropriate T stage of this neoplasm? discharge from one duct orifice in her right nipple
a. T1 b. T2 c. T1a d. T4 e. T3 one month ago. The sonographic examination
11. A 50 year-old woman has been referred to the revealed a dilated duct enclosing a mass. What is
breast clinic with a small ulcerating lesion over her the most probable diagnosis?
right nipple and areola. There is no evidence of a. Paget's disease of the nipple
palpable breast lumps on clinical examination. b. Intraductal carcinoma
What is the appropriate management at this c. Intraductal papilloma
stage? d. Duct ectasia
a. Ultrasonography and core biopsy 15. A 51- year-old woman presents with a history
b. Mammogram and core biopsy of a recent bloody nipple discharge from the left
c. Stereotactic biopsy d- A Trial of Topical steroid breast. There is no change in the skin colour of the
cream for 4 weeks nipple, but a 5 mm swelling is palpable medially at
d. Mammogram and punch biopsy the margin of the areola. Pressure on the nodule
provokes a bloody discharge from the nipple.
Which of the following is the most likely diagnosis?
a. Duct papilloma. b. Fibroadenoma.
c. Intraductal carcinoma.
d. Paget's disease of the nipple

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16. A 61-year-old woman has an itchy nipple. This 20. A 52 year-old Yamani lady has been admitted
persists despite application of a corticosteroid to general surgical ward and undergone a modified
cream. Her breast skin is indurated, roughened radical mastectomy for a 3cm malignant lump in
and reddish-orange. The core biopsy showed an the upper outer quadrant of the left breast. During
invasive ductal carcinoma with malignant cells in the operation; several matted hard and, fixed
dermal lymphatics.Which of the following is the nodes were found in the ipsilateral axilla. All
most appropriate T stage of this neoplasm? investigations for disease spread were negative.
a. T1 b. T2 c. T1a d. T4 Which stage of breast cancer is this?
17. A 40- year-old woman is found to have a 3 cm a. T1N1M0 b. T1N2M0
firm smooth mass in the upper outer quadrant of c. T2N1M0 d. T2N2M0
the breast. The mass is aspirated and 10 ml of e. T2N3M0
cloudy green fluid is removed. Cytology and 21. A 40 year-old woman is found to have a 3 cm
microbiology on the fluid are negative. What is the firm smooth mass in the upper outer quadrant of
most appropriate follow up for this woman? the breast. The mass is aspirated and 10 ml of
a. Mammogram at 6 months yellow fluid is removed. Cytology and microbiology
b. No further action on the fluid are negative for malignancy. What is
c. Ultrasound at 2 weeks the most appropriate follow up for this woman?
d. Urgent CT scan of the breast a. Mammogram at 6 months
18- Mrs. Zeinab is a 20-year-old woman who found b. No further action
a lump in her left breast on routine breast self- c. Ultrasound at 2 weeks
examination. She is an otherwise healthy woman d. Urgent CT scan of the breast
with no significant past medical history. 22. A 30-year-old woman came to the hospital with
Examination confirmed a 1.5 cm mass at 3 o’clock fever and pain in the right breast. She was a breast
in the left breast. What is the best initial feeding mother. Physical examination, the breast
radiological investigation in this case? looked red and there were fluctuation and pain
a. Breast ultrasound during palpation. What is the most likely diagnosis?
b. Mammography. a. Adenosis b. Breast cancer
c. Breast MRI c. Fibro adenoma d. Fibrocystic changes
d. Positron emission tomography e. Mastitis with abscess
19. A 60 year-old woman found a 1.5 cm lump in 23. A-34-year- lactating female presented to OPD.
the upper outer quadrant of her left breast, which With 5 days breast pain which became throbbing.
is confirmed by biopsy as invasive duct carcinoma, Exam. Showed that her left breast is enlarged,
grade2. There was one palpable ipsilateral axillary red and tender.What is the most probable
lymph node. Which of the following data is diagnosis
relevant as regards staging of her disease? a. Fibroadenosis b. Breast abscess
a.Tumour size c. Duct ectasia d. TB.mastitis
b.Tumour site
c. Tumour pathology
d. Tumour grade

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24. A 60 -year-old woman found a 1.5 cm lump in Thyroid
the upper outer quadrant of her left breast, which is
confirmed by biopsy as invasive duct carcinoma, 1. A 74 -year- old male presented to your OPD
grade 2. There was one palpable ipsilateral axillary complaining of neck swelling of about 8 months
lymph node. Which of the following data is relevant duration that rapidly grows in size. Two weeks ago
as regards staging of her disease? he started to feel difficulty in breathing and his
a. Tumour size b. Tumour site voice became not as before. Exam showed a
c. Tumour pathology d. Tumour grade swelling in the anterior aspect of his neck that
e. Number of lymph nodes seems to be hard in consistency. What is the most
probable diagnosis?
25. A 30 year-old lady discovered a breast lump by a. Follicular carcinoma
self examination which was then surgically b. Medullary carcinoma
removed and confirmed to be malignant by c. Anaplastic carcinoma
histology. Which of the following findings in this
tumor is indicative of a good prognosis? d. Papillary carcinoma
a. Over-expression of the HER2 proto-oncogene 2. A 45 -year-old female with progressive
b. Size less than 5 cm in maximum diameter enlargement of a multinodular goiter that causes
c. Intraductal carcinoma without invasive component symptomatic tracheal compression. She has no
d. Negative estrogen and progesterone receptors other symptoms or co-morbid conditions. What is
e. The young age of the patient the preferred management?
a. Increase oral iodine
26. A premenopausal 44-year-old woman b. Thyroid hormone replacement
undergoes a quadrantectomy and node dissection c. Thyroidectomy
for a 2-cm infiltrating carcinoma of the left breast. d. Radioactive iodine
The margins are clear, and 5 out of 15 lymph nodes 3. A male patient 67- years- of age presented to
are involved. ER and PR are positive. the OPD with 6 months duration of a swelling in
Recommended adjuvant therapy should include the anterior aspect of the neck which moves with
which of the following? swallowing, about 4X5cm in dimensions, hard in
a. Estrogen therapy alone consistency, the skin over is adherent to the gland.
b. Modified radical mastectomy What is the most likely diagnosis?
c. Chemotherapy alone a. De Quervain's thyroiditis.
d. Chemotherapy, radiotherapy, and tamoxifen b. Papillary thyroid carcinoma.
c. Anaplastic thyroid carcinoma.
d. Medullary thyroid carcinoma.
e. Follicular thyroid carcinoma
4. A 26-year-old female presents to her GP
experiencing symptoms of headache, anxiety,
sweating and palpitations. She had previous
similar attacks. On examination, she has
hypertension and enlarged smooth soft thyroid
swelling.What is the most probable diagnosis?
a. Riedl's disease b. Grave's disease
c. Multinodular thyroid d. Hashimoto's disease

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5. A 42-year-female presented to OPD with a. Total thyroidectomy with bilateral central lymph
swelling in the front of her neck of 5 years node clearance.
duration. There were no other symptoms. General b. Hemi thyroidectomy with unilateral central lymph
examination revealed no remarkable general node clearance.
findings. Locally the swelling moves up with c. Subtotal thyroidectomy with bilateral central
swallowing with some irrigularity.What is the most lymph node clearance.
probable diagnosis? d. Preoperative radioactive iodine therapy followed
a. Physiologic goiter b. Toxic goiter by total thyroidectomy.
c. Simple nodular goiter d. Colloidal goiter e. Thyroxin about (100-200mcg/ day) to suppress
6. You are called straight to the operation room for TSH as preliminary treatment.
39 years old female patient who underwent 10. A firm, solitary, "cold" nodule in the lateral
thyroidectomy. During recovery the patient aspect of the left lobe of the thyroid in a 20 year-
develops severe stridor that necessitates re- old female is best managed by:
intubation. The patient most likely had: a. Irradiation (Radioactive iodine)
a- Laryngeal hematoma b. Thyroid suppression with thyroxin
b- Laryngeal edema c. Incisional biopsy and enucleation if benign
c- Bilateral vocal fold paralysis d. Total thyroidectomy
d- Unilateral vocal fold parlaysis e. Left thyroid lobectomy
7. A 40-y lady presents with history of goiter for 11. A 33 year old woman presented with weight
last eight years. However, she now noticed excess loss, palpitations, tachycardia, weakness in the
sweating, weight loss and palpitation. Her serum knees, and she reported that she felt hot all the
T4 is raised. The patient is subjected to surgery. time. Her doctor diagnosed Graves' disease
Which of following postoperative problems can be (thyrotoxicosis) due to which of the following
avoided by proper preoperative preparation? clinical signs or laboratory investigations?
A. Hypoparathyroidism. a- Absent reflex ankle jerk
b. Hyperparathyroidism. b- Elevated serum calcium
c. Hypothyroidism. c- Elevated serum TSH
d. Thyroid storm d- Exophthalmos
8. A 40-year-old male presents with hoarseness of e- Normal T3 and low T4 in serum
voice two weeks after thyroid surgery. What is the 12. A 40-year-old lady presents with history of
most appropriate investigation to reach the goiter for the last three years. Now, she complains
diagnosis? of insomnia, excess sweating, weight loss and
A. X ray neck AP and lateral view. palpitation. Her serum T4 is raised. The patient is
B. Direct laryngoscopy under GA subjected to surgery. Which of the following
C. CT scan of neck without contrast. postoperative problems can be avoided by proper
D. MRI of neck without contrast preoperative preparation?
9. The most appropriate management of 3x4 cms a) Hyperparathyroidism.
solitary thyroid nodule diagnosed as papillary b) Hyperparathyroidism.
carcinoma of thyroid in a 60 year old man is: c) Hypothyroidism.
d) Thyroid storm.

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13. A 50-year-old man presented to the outpatient 17. A 33 –year- old lady with Graves's disease,
clinic with swelling in the lower part of the front of preoperative assessment revealed her Hb as 9.9
the neck. He states that throughout the past six gm/dL, blood sugar of 10mmol/dL, serum T4 of
months he had palpitations, feeling hot all the 29mmol/L (6-16 mmol/L),, serum calcium 2.30
time, anxiety and insomnia. He has noted mmol/L (normal range- 2.20 to 2.50 mmol/L) and
increased appetite over the last month with no serum albumin of 32 mg/L.Prior to subjecting her
weight gain, and more frequent bowel movements for surgery, what is the most important item to be
over the same period. What is the most relevant corrected?
investigative tool in such case? a. Hemoglobin b. Serum calcium
a. Thyroid scan c. Albumin d. T4
b. Thyroid hormone essay e. Blood sugar
c. Neck ultrasound 18-A 74 -year- old male presented to your OPD
d. Fine needle aspiration cytology complaining of neck swelling of about 8 months
14- A 45 year-old female with progressive duration that rapidly grows in size. Two weeks ago
enlargement of a multinodular goiter that causes he started to feel difficulty in breathing and his
symptomatic tracheal compression. She has no voice became not as before. Exam showed a
other symptoms or co-morbidity. What is the swelling in the anterior aspect of his neck that
preferred management? seems to be hard in consistency. What is the most
a. Increase oral iodine probable diagnosis?
b. Thyroid hormone replacement a. Follicular carcinoma b. Medullary carcinoma
c. Surgical resection c. Anaplastic carcinoma d. Papillary carcinoma
d. Radioactive iodine 19. A 23 year-old woman sought medical assistance
15. A 56- year old female with a history of papillary for a swelling of her thyroid over the last two years.
thyroid carcinoma, for which she underwent total She was treated for cervical tuberculosis with
thyroidectomy one year ago, found to have a radiotherapy as a child. What is the diagnostic
rising thyroglobulin level during follow up. What is investigation that must be done?
the most informative next investigation in such a) Tc-99 pertechnetate isotope scan
case? b) CT scan of the neck and thorax
a. Radioactive Iodine scan
c) Manteux test
b. Neck ultrasound
d) Fine needle aspiration biopsy
c. Neck MRI
20- A 28 -year-old asymptomatic female presents
d. Neck CT scan
for her annual physical examination. A 2 cm firm,
16. In what type thyroid cancer, Calcitonin assays
smooth, nodule is noted in the right lobe of the
is of value in detecting recurrence?
thyroid. There is no associated lymphadenopathy.
a. Anaplastic carcinoma
There is no history of previous head or neck
b. Follicular carcinoma
irradiation. Her TSH is normal. What is the most
c. Medullary carcinoma
appropriate diagnostic investigation?
d. Papillary carcinoma
a. Ultrasound of the neck
e. Thyroid lymphoma
b. Thyroid scan
c. Measurement of serum thyroglobulin
d. Fine needle aspiration biopsy of the lesion

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21. A firm, solitary simple nodule in the lateral SALIVARY GLANDS
aspect of the left lobe of the thyroid in a 20 year-
old female, what is its best managed? 1. A 50 -year-old afebrile patient presents with
a. Irradiation (Radioactive iodine) recurrent swelling in the submandibular region for
b. Thyroid suppression with thyroxin the last year. It becomes painful only during
eating. Clinical examination shows firm tender
c. Incisional biopsy and enucleation if benign
smooth swelling in right submandibular region.
d. Total thyroidectomy What is the most likely diagnosis?
e. Left thyroid lobectomy( Hemi-thyroidectomy) a. Suppurative submandibular lymphadenitis
22. A 33 year old lady with Graves's disease was b. Sialectasis of submandibular gland
referred by endocrinologist for surgical c. Tuberculous sialadenitis
management as she refused long term antithyroid d. Sialolithiasis (Stone in the gland)
drugs or radioactive iodine therapy. Preoperative
assessment revealed her Hb as 9.9 gm/dL, blood 2. A 43 year-old female presents to her doctor with
sugar of 10mmol/dL, serum T4 of 21mmol/L (6-16 a 2cm mobile swelling in front of and slightly
mmol/L), serum calcium 2.30 mmol/L (normal below her right ear. It has been present for about
range- 2.20 to 2.50 mmol/L) and serum albumin of one year. The patient asks her doctor what this
32 mg/L. Prior to subjecting her for surgery the swelling could be. The doctor tells his patient that
he will be referring her to the hospital. In answer to
most important requisite is to correct her levels of
the patient's question about the nature of her
a. Hemoglobin b. Serum calcium problem the doctor tells her the following:
c. T4 d. Blood sugar "These are the commonest growths of the salivary
23. A 42-year-female presented to OPD with glands, occurring most frequently in the glands at
swelling in the front of her neck of 5 years the angle of each jaw; their cause is unknown and
duration. There were no other symptoms. General when removed there is a small chance that the
examination revealed no remarkable general tumour may return again" What tumour was the
findings. Locally the swelling moves up with family doctor thinking of?
swallowing with some irrigularity.What is the most a-Warthins tumour
probable diagnosis? b-Mucoepidermoid carcinoma
a. Physiologic goiter c-Monomorphic adenoma
b. Toxic goiter d-Pleomorphic adenoma
c. Simple nodular goiter e-Acinic cell carcinoma
d. Colloidal goiter

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 Swelling 6. Male patient, barber, 34-year-presented to your
OPD with dull aching pain in his scrotal region. On
1. A 36-year- female patient, complaining of slowly examination there was a bluish mass lesion in his
growing painless swelling in her arm. By left hemiscrotum that is extending up,
examination you found that the swelling is compressible and disappears on lying down. That
subcutaneous with lobular surface and well defined swelling is mostly:
slippery edge. What is the most likely diagnosis? a. .TB.funiculitis.
a. Sebaceous cyst b. Subcutaneous lipoma b. encysted hydrocele of the cord.
c. Epidermoid cyst d. Branchial cyst c. indirect inguinal hernia.
2. A 26 year-old male presents with a 5 cm non- d. varicocele
tender fluctuant mass in the right jugulodigastric e. Vaginal hydrocele
area anterior to the sternocleidomastoid muscle. 7. A 70-year-old patient who is a known diabetic
What is the most likely diagnosis? presented with central abdominal pain and back
a. Ectopic thyroid b. Branchial cyst pain. On examination a pulsatile mass was felt just
c. Hypoglossal duct cyst d. Sebaceous cyst above the umbilicus. What is the best
e. Pharyngeal fistula investigation to assess this problem?
3. A 7 – year - male patient, complaining of a slowly a. Abdominal ultrasound.
growing painless subcutaneous swelling below the b. Plain abdominal CT scan.
lateral end of his left eyebrow. By examination you c. Contrast abdominal CT.
found that the swelling is subcutaneous, painless, d. Angiography.
lax cystic, well defined edges. What is the most 8. A 50 y man noticed lump in lateral aspect of his
likely diagnosis? neck since 3 months which didnot improve with
a. Sebaceous cyst b. Dermoid cyst course of antibiotics. There were no other
c. Subcutaneous lipoma d. Branchial cyst complaints. Exam. revealed a firm mobile, 2cm
swelling at left carotid triangle of neck and no
4. A 7- year- old. male patient, complaining of a
other abnormalities. What is best single
slowly growing painless subcutaneous swelling in
the lateral aspect of his eye brow. By examination investigation?
a. Excisional biopsy.
you found that the swelling is subcutaneous,
painless, cystic, well defined edges. What do you b. Incisional biopsy.
c. Core-biopsy
suspect this lesion is?
d. FNA cytology
a. Sebaceous cyst
9. A 65-year-old man presented to OPD with an
b. Congenital dermoid cyst
irregular ulcer in the Rt. margin of the tongue.
c. Subcutaneous lipoma
Clinical examination of the ulcer showed an
d. Branchial cyst
everted edge and necrotic floor. It is associated
5. A 5-years-old patient presented to clinic by
with enlarged cervical lymph nodes. What is the
midline neck mass just below the hyoid bone, which
most likely diagnosis?
moves with, protrusion of the tongue. The mass, is
a. Rodent ulcer
most likely to be.
b. Squamous cell carcinoma
a. Branchial cyst. b. Cystic hygroma. c. Marjolin’s ulcer
c. Teratoma. d. Thyroglossal cyst. d. Aphthus ulcer
e. Laryngeal papilloma

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10. A 34 year-old male presents with history of
painless swellings on both sides of the neck for the
last six months. On examination there are
discrete, mobile swellings rubbery in consistency
over both sides of the neck, axillae and inguinal
regions. Biopsy of the lymph nodes reveals
predominance of lymphocytes and Reid Sternberg
giant cells. The most appropriate treatment of this
patient is:
a. Surgical excision
b. Radiotherapy
c. Chemotherapy
d. Immunotherapy
11. A 19 year old woman presents with 6 months
history of fever and weight loss. Physical
examination reveals a 3cm node in the axilla and
hepatosplenomegaly. What is the most likely
diagnosis?
a. Lymphoma b. Breast cancer
c. Lung cancer d. Tuberculosis
12. A 19 year old woman presents with 6 months
history of fever and night sweats. Physical
examination reveals a 3cm node in the left axilla
and hepato-splenomegaly. Chest X-ray reveals
bilateral hilar adenopathy. What is the most likely
diagnosis?
a. Lymphoma b. Breast cancer
c. Lung cancer d. Tuberculosis

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