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1- Acute abdominal pain which is

(all correct except on)

Acute Abdomen

A. Colicky in nature indicates obstruction of hollow viscus. B. In right upper quadrant increased by inspiration is typical of cholecystitis C. Continuous is typical of inflammation D. Maximal in the right loin is typical with duodenal ulcer. E. Maximal in epigastrium and related to meal is typical of gastric problem.

2- Vomiting in acute abdomen


A. Occurring soon after the oncet of colicky pain indicates pathology outside the gastrointestinal tract. B. Of fluid containing no bile is characteristic of small bowl obstruction C. Of faeculent fluid usually indicates gastrointestinal fistula. D. Of bile stain fluid usually indicates stomach outlet obstruction E. B&C only

3- Faeculent vomiting:
A. Is commonly seen after upper gastrointestinal tract bleeding. B. Indicates large bowel obstruction. C. Indicates bacterial proliteration in the upper intestinal. D. Suggests a gastro-colic fistula. E. Suggests small bowel fistula

4- A patient with generalized peritonitis: (all correct except one)


A. Usually has an elevated temperature and pulse rate. B. Characteristically complains of spasmodic severe pain which causes him to be restless. C. Is characteristically vomites. D. Will usually have a rapid and deep respiratory pattern. E. Is Usually has an elevated WBCs.

5- A perforated duodenal ulcer:


A. Usually lies on the anterior or superior surface of the duodenum. B. Usually presents with the acute onset of severe back pain. C. Produces radiological evidence of free gas in the peritoneum in over 90 percent of the patients. D. Is usually treated by vagotomy and pyloroplasty E. Is usually treated conservatively.

6- Congential pyloric stenosis: (all correct except one)


A. Occurs more commonly in male children. B. Usually presents in the first few days of life. C. Presents with non bile stained vomiting. D. Is usually diagnosed on clinical examination. E. May cause right upper quadrant tenderness.

7- Appendicitis is:
A. More common in females B. Distributed evenly thoughout the world's population C. More likely to occur if the appendix is in the retrocaecal position. D. Commonly the result of appendicular obstruction. E. B&C only.

8- Likely differential diagnoses in a young woman with appendicitis include:


A. Ovarian carcinoma B. Ruptured ectopic pregnancy. C. Colonic diverticulitis. D. Caecal carcinoma. E. C&D only.

9- Obstruction of the lumen of the appendix may lead to: (all correct except one)
A. Mucosal ulceration B. Gangrenous appendicitis. C. A perforated appendix. D. Intussusception of the appendix. E. Acute appendicitis.

10- Acute non-specific mesenteric lymphadenitis: (all correct except one)


A. Is commonest between 5 and 12 years of age. B. Is usually associated with an upper respiratory tract infection. C. Is usually associated with cervical lymphadenopathy D. Is characterized by enlarged mesenteric lymph nodes which are infected by gramnegative organisms. E. Is one of the differential diagnosis of acute appendicitis.

11- The level of intestinal obstruction can be determined by: (all correct except one)
A. Questioning the patient. B. Examining the patient. C. Radiological examination of the patient. D. Repeated measurements of the patient's girth. E. Upper & lower contrast studies.

12- Acute small bowel obstruction: (all correct except one)


A. Is commonly caused by postoperative adhesions. B. Accompanied by the signs of peritonitis, suggests bowel strangulation. C. Is often associated with a raised serum amylase. D. Generally produces abdominal distension within 2 to 3 hours of onset. E. Can be diagnosed by history and clinical examination.

13-In the treatment of intestinal obstruction:


A. Nasogastric suction should be instituted preoperatively. B. Intravenous fluid replacement might be required. C. Immediate surgery is essential. D. Surgery should be restricted to those cases where strangulation is diagnosed. E. C&D only.

14- Strangulation of the bowel: (all correct except one)


A. commonly complicates closed loop obstruction. B. Is difficult to distinguish from simple intestinal obstruction. C. Is accompanied by bleeding into the affected bowel. D. Frequently causes peritonitis. E. Is characterized by severe abdominal pain.

15- Large bowel obstruction:


A. Is most commonly caused by colonic cancer B. Has its maximum incidence before the age of 50. C. Frequently presents with nausea and vomiting. D. Usually heralds its onset with constant suprapubic pain. E. Frequently treated conservatively.

16- Patients with acute colonic deveticulitis:


A. Often give a history of recent lower abdominal colic. B. Often present with pyrexia. C. Can be frequently diagnosed on sigmoidoscopic appearances. D. Frequently develop faecal peritonitis. E. All the above.

17- Acute pancreatitis typically: (all correct except one)


A. Is accompanied by hypercalcaemia. B. Produces paralytic ileus. C. Is associated with a pleural effusion. D. Produces pyloric stenosis. E. Upper abdominal pain and vomiting.

18- Acute pancreatitis: (all correct except one)


A. Often simulates a perforated peptic ulcer in its presentation. B. Often presents with the signs of hypovolaemia. C. Can readily be distinguished from other causes of acute abdominal pain by the presence of a raised serum amylase. D. Frequently has a raised concentration of urinary amylase. E. Most commonly caused as a complication of GB stones.

19- The treatment of acute pancreatitis:


A. Is largely nonspecific and supportive. B. Should include a laparotomy in the majority of cases. C. Should routinely include the administration of calcium. D. Should routinely include the administration of antibiotics. E. All the above.

20- Childhood intussusception: (all correct except one)


A. Usually presents during the first year of life. B. Is frequently ileocolic. C. Can usually be diagnosed without x-ray examination of the abdomen. D. Rarely requires surgical treatment. E. Can be diagnosed by abdominal US.

21- Meconium ileus:


A. Is the presenting feature in the majority of patients with cystic fibrosis. B. Is associated with achlorhydria. C. Presents with a distended abdomen and bilious vomiting. D. Often can be effectively treated with acetyl cysteine. E. All the above.

22- Neonatal duodenal obstruction:


A. May be associated with down's syndrome. B. Is more frequently found in premature infants. C. Typically presents with gross abdominal distension. D. Usually presents with vomiting of non-bile stained fluid E. B&C only. 4

23- acute superior mesenteric artery occlusion: (all correct except one)
A. Characteristically presents with sudden pain and tenderness of increasing intensity. B. Is frequently accompanied by overt or occult blood loss in the stools. C. Frequently produces peritonitis. D. Can usually be diagnosed on plain abdominal x-rays. E. Can be diagnosed by mesenteric artery ongiography.

24- A ruptured ectopic pregnancy: (all correct except one)


A. Usually occurs in the first month of pregnancy. B. Usually presents with severe lower abdominal pain. C. Frequently presents with hypovolaemic shock. D. Can usually be diagnosed by pelvic examination. E. Can usually be diagnosed by transvaginal US.

25- Biliary colic typically:


A. Occurs 3 to 4 hours after meals. B. Lasts 5 to 20 minutes. C. Radiates from the upper abdomen to the right subscapular region. D. Is made better by deep inspiration. E. B&C only.

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