Você está na página 1de 25

GENERAL SURGERY : SKIN (POST TEST)

1. Epidermal inclusion cyst is:


a. due to obstruction of secretion from the sebaceous glands :Hydadenitis Suppurativa
b. They may contain hair, tooth and creamy substance: Dermoid Cyst
c. More common in female Trichelemmal Cyst
d. Accumulated desquamated stratum corneum
2. Skin color is dependent on the following except:
a. Density of the melanocytes
c. degradation of melanosomes
b. Melanin production
d. genetic factor
3. Scalded Skin Syndrome is
a. A hypersensitivity reaction to drugs c. due to the toxin produced by Streptococcus
b. Bullous eruption can involve the GI system d. mainly affects the skin
4. All are true regarding sweat except:
a. Produced by eccrine glands
b. They are hypertonic hypotonic

c. has less sodium compared to plasma


d. 500-700 ml of sweat are lost insensibly/day

5. Layer of the skin that contains the intricate network of blood vessels that regulates body temp
a. Epidermis
b. horny layer c. reticular dermis
d. papillary dermis
6. Cutaneous receptors for cold temp
a. Pacinian corpuscle b. Krause and bulb c. meisners corpuscle

d. Ruffinis ending

7. With regards to basal Cell CA, which of the ff is true?


a. They readily spread distally SCC
b. It originate from keratinocytes: SCC
c. They spread primarily through hematogenous route: SCC
d. They are from the pluripotent cells of the epidermis
8. All are adnexal structures of the skin except
a. Eccrine glandsb.apocrine glands
c. sensory nerve ending

d. sebaceous gland
1

9. On what layer of the skin can you find glomus bodies


a. Papillary dermis
b.reticular dermis

c. basement membrane d.epidermis

10. Type of malignant melanoma common among colored race


a. Lentigomaligna
b. acrallentigenous c. nodular

d. superficial spreading

GENERAL SURGERY: MANIFESTATION OF GIT PRETEST AND POST TEST


PRETEST
1. Which of the following statement is/are TRUE concerning physical finding of a mechanical bowel obstruction?
a. Dehydration is rarely present before vomiting develops
b. In the 1st 12 hours of obstruction, severe sepsis and toxemia can be already be seen
c. Tenderness to palpation may be absent between episodes of pain, but may be quite severe during colicky episodes
d. Complete silence of the abdomen is a good sign and suggest paralytic ileus
e. All of the above
2.
a.
b.
c.
d.
e.

What pattern of vomiting is seen in Chronic gastric outlet obstruction?


Delayed vomiting of large volume of partially digested food
Vomiting without antece3edent nausea
Vomiting immediately after eating
Projectile vomiting
All of the above

3. Concerning adynamic ileus, w/c of the ff statement/s is/are TRUE.


a. Pseudo-obstruction of the colon is easily differentiated from mechanical colonic obstruction with plain films of the abdomen
2

b. In most instances, the management of ileus in nonoperative and is directed at the underlying predisposing abnormality
c. Except for the stomach, all segments of the GIT recover from adynamic ileus at approximately the same rate
a. Small intestines in 8 hours
b. Stomach in 1-2 days
c. Colon in 3-4 days
d. Radiographic finding will show gaseous distension of the small bowel with small amount of gas in the colon
e. All of the above
4.
a.
b.
c.
d.
e.

With regard to acute appendicitis, w/c of the ff is/are TRUE?


Early antibiotic treatment decreases the incidence of perforation
Vomiting usually precede pain: PAIN 1st
Obstipation or diarrhea is never a manifestation
Pain is often begins in the periumbilical area
All of the above

5.
a.
b.
c.
d.
e.

With regard to GI bleeding, w/c of the ff statements is/are TRUE?


Approximately 500ml of GI blood loss is required to produce melena: 50 mL
The hematocrit level is a reliable measure of ones blood volume during the 1st 6 hours following acute episode of GI bleeding
Bleeding from the proximal jejunum usually presents as both hematemesis and melena
Upper GI contrast study should be employed as the initial technique in cases of active upper GI bleeding
Hematemesis is limited to the vomiting of fresh blood from a source proximal to the ligament of Treitz

POST TEST GIT MANIFESTATION


1. Moderate gaseous distension of entire small and large bowel - ILEUS
2. Gaseous distension of small bowel with no gas in the colon COMPLETE SMALL BOWEL OBSTRUCTION
3. Distended colon from cecum to descending colon w/ no small bowel gas COLONIC OBSTRUCTION WITH
COMPETENT ILEOCECAL VALVE
4. Massively dilated large colon with no evidence of distal colonic obstruction OGILVIES SYNDROME
5. Omega sign SIGMOID VOLVULUS
6. Murphys sign ACUTE CHOLECYSTITIS
7. RLQ pain on passive internal rotation of right thigh ACUTE APPENDICITIS
8. Cullens sign ACUTE HEMORRHAGIC PANCREATITIS
3

9. Courvoisier sign PERIUMPULLARY CANCER


10. Cervical motion tenderness - PID
POST TEST SURGERY
(APPENDIX)
1.

2.

3.

4.

5.
6.
7.

8.
9.

a. Lumen is lined by pseudocolumnar epithelium


b. Escherichia coli is the most common pathogen
c. None of the above
The most common form of obstruction:
a. Hypertrophy of lymphoid tissue
b. Fecalith
c. Intestinal worms
d. Vegetable & fruit seeds
Rapid distention of the appendix after its luminal obstruction is due to:
a. Presence of Bactiroides fragilis
b. Increase permeability of its blood vessel wall
c. Goblet cells
d. All of the above
True about appendicitis:
a. More common in female
b. Peak incidence is 50 yrs
c. The incidence is inevitable & subside spontaneously
d. None of the above
The most common earliest symptom of appendicitis is: anorexia
The best guide used by surgeon in diagnosis of appendicitis is: clinical history & P.E.
The following are abdominal signs for appendicitis, except:
a. Murphys sign
b. Rovsing sign
c. Psoas sign
d. Obturator sign
False (+) pre-op diagnosis of acute appendicitis is indicated: obese patient
Signs suggestive of appendiceal rupture:
4

a. Direct & rebound tenderness


b. ill-defined bendiness mass at the right iliac region
c. WBC of 14,000/mm3
d. All of the above
10. Most important finding in urinalysis: bacteriuria
POST TEST SURGERY
(APPENDIX)
1.

2.

3.

4.

5.
6.
7.

a. Lumen is lined by pseudocolumnar epithelium


b. Escherichia coli is the most common pathogen
c. None of the above
The most common form of obstruction:
a. Hypertrophy of lymphoid tissue
b. Fecalith
c. Intestinal worms
d. Vegetable & fruit seeds
Rapid distention of the appendix after its luminal obstruction is due to:
a. Presence of Bactiroides fragilis
b. Increase permeability of its blood vessel wall
c. Goblet cells
d. All of the above
True about appendicitis:
a. More common in female
b. Peak incidence is 50 yrs
c. The incidence is inevitable & subside spontaneously
d. None of the above
The most common earliest symptom of appendicitis is: anorexia
The best guide used by surgeon in diagnosis of appendicitis is: clinical history & P.E.
The following are abdominal signs for appendicitis, except:
a. Murphys sign
b. Rovsing sign
5

c. Psoas sign
d. Obturator sign
8. False (+) pre-op diagnosis of acute appendicitis is indicated: obese patient
9. Signs suggestive of appendiceal rupture:
a. Direct & rebound tenderness
b. ill-defined bendiness mass at the right iliac region
c. WBC of 14,000/mm3
d. All of the above
10. Most important finding in urinalysis: bacteriuria
POST TEST SURGERY
(GIT)
1. Characteristics of adynamic ileus, except:
a. Commonly seen after a variety of abdominal operations
b. Most common ileus,
c. Gastric ileus occurs w/in 2 days
d. Described as tightly contracted bowel w/o propulsive activity
e. Colonic ileus lasts 3 4 days
2. Characteristic of visceral pain, except:
a. Characterized by A-delta fibers
b. Responsive to distention, traction
c. Innervated by autonomic C-type fibers
d. Poorly localized
e. All of the above
3. Most common cause of GI bleeding in pediatric patient:
a. Ileus
b. strangulation
c. esophageal varices
d. obstruction
e. diverticulosis
4. In auscultation which condition presents w/ absent bowel sound, except:
a. narcotic overdose
6

b. mesenteric thrombosis
c. early small bowel obstruction
d. ileus
e. peritonitis
5. Significant weight loss: 10 15% w/in 3 4 months
6. Cardinal signs of obstruction, except:
a. Crampy abdominal pain
b. Nausea & vomiting
c. Obstipation
d. Crampy abdominal distention
e. Anorexia
7. Most common cause of small bowel obstruction
a. Malignancy
b. Diverticulosis
c. Volvulus
d. Strangulated hernia
e. Post operative adhesions (60 80%)
8. Most common etiology of acute constipation:
a. In elderly, prolapse
b. Due to laxative abuse
c. Congenital disease such as Hirschsprung Disease
d. Innervations rupture
e. Most often mechanical in orgigin like anal fissure & thrombosed hemorrhoids
9. Most common cause of upper GI bleeding: bleeding peptic ulcer disease
10. Characteristics of angiodysplastic lesion, except:
a. Degenerative
b. Lesion < 5mm diameter
c. Common in Cecum & right colon
d. Associated w/ other vascular lesion of viscera or skin
e. Increase w/ age
Manifestation of GIT disease
1. Manifest as colicky pain radiating to the right scapular area
7

2.

3.

4.

5.

6.

7.

A. Myocardial Ischemia
B. Gallstone
C. Reflux Esophagitis
D. PUD
Distinguishes gas from fluid distention
A. Inspection
B. Palpation
C. Percussion
D. Auscultation
Elicits point tenderness and muscle guarding
A. Inscpection
B. Palpation
C. Percussion
D. Ausculatation
Almost always heralds intraabdominal disease but might not indicate the need for surgical therapy
A. Visceral pain
B. Somatic pain
C. Parietal pain
D. Well localized, sharp pain
Anorexia is due to
A. Decrease glucose level
B. Lesion on the lateral area of hypothalamus
C. Lesion on ventro-medial region of hypothalamus
D. Decrease lipolysis and oxidation
In 90% of cases, UGIB can be differentiated from LGIB by
A. Rectal exam
B. Color of stool
C. Inserting NGT
D. Color of vomitus
The most common cause of secondary peritonitis is
A. Systematic lupus erythema
B. Perforated viscus
C. 2 cirrhosis
8

D. Abdominal abscess
8. The radiologic signs in intestinal obstruction
A. Gas scattered through colon
B. Definite step ladder fluid levels in intestine
C. Elevated diaphragm
D. Gas diffusely through intestine
9. The parietal pain is characterized by the following
A. Poorly localized
B. Originate segments of spinal cord
C. Innervated by pain fibers
D. Affecting the visceral pressure
10. Close loop obstruction is characterized by following
A. Slow progression of obstruction
B. Usually does not strangulate
C. Occurs in competent ileococal valve
D. Decrease in secretory pressure
11. In 95% of pediatric population, the most common cause of UGIB is
A. Gastritis
B. Esophageal varices
C. Esophagitis
D. Stress ulcer
12. The most common cause of adynamic ileus
A. Hypokalemia
B. Prolonged operative manipulation
C. Hypomagnesemia
D. Hyponatremia
13. Management in mechanical bowel obstruction
A. Correct fluid and electrolyte imbalance
B. Insert NGT for decompression of GIT
C. Surgical intervention once diagnosis is done
D. All of the above
14. The characteristics of visceral pain
A. Due to stretching and contraction
9

B. Pain is sharp and persistent


C. Related peritoneal signs
D. Localized to the dermatome distributions
15. Peritoneum is described as following
A. Formed double layer of mesotheled cells
B. Composed of cuboidal and flattened cells without gaps
C. Parietal peritoneum covers the visceral organs
D. Visceral peritoneum innervated by autonomic nervous system
16. In visceral pain, the dermatome distribution of the small intestine is
A. T5~T7
B. Vagus
C. S2~S4
D. T8~T10
17. The possible origins for referred pain in right shoulder
A. Spleen
B. Stomach
C. Small intestine
D. Diaphragm
18. Singultus is characterized by the following
A. Irritation of the diaphragm
B. Managed only by direct pharyngeal stimulation
C. Can because by intra abdominal infection
D. Stimulation of phrenic nerve
19. The most common electrolyte imbalance in vomiting
A. Hyponatremia
B. Hypoglycemia
C. Hypochloremia
D. Hypokalemia
20. The predominant gases in the flatulence
A. Hydrogen sulfide
B. Nitrogen
C. Fatty acids
D. Volatile amino acids
10

21. The conditions where there is sudden onset of pain


A. Chronic pancreatitis
B. Cholecystitis
C. Perforated viscus
D. Pneumonia
22. The most common cause of lower gastrointestinal bleeding in adult over 60 years
A. Meckels diverticulum
B. Polyps
C. Vascular Ectasias
D. Diverticulosis
23. The acute conditions where anorexia is prominent manifestation
A. Carcinoma of stomach
B. Appendicitis
C. Congestive heart failure
D. Diabetes mellitus
24. In dysphagia, the following laboratory work up can be done
A. Colonoscopy
B. Barium swallow
C. Plain abdominal x-ray
D. Ultrasound
25. The management of adynamic ileus except
A. Decompression of GIT
B. Correct electrolyte imbalance
C. Prolonged ileus can need parenteral feeding
D. Surgical intervention
26. Etiology of upper gastrointestinal bleeding
A. Angiodysplasia
B. Peptic ulcer
C. Ulcerative colitis
D. Diverticulitis
27. Most common etiology of intestinal obstruction
A. Adhesions
B. Cancer
11

C. Hernia
D. Idiopathic
28. Psychogenic cause of constipation
A. Tumor
B. Pelvic floor abnormality
C. Absent myenteric plexua
D. Improper training
29. Substernal burning associated with bitter taste
A. Dyspepsia
B. Odynophagia
C. Singultus
D. Heartburn
30. Subjective manifestation of a disturbance in function and represent pathophysiologic state
A. Symptom
B. Sign
C. Fever
D. Melena
31. Minimum amount of gastrointestinal bleeding per day to give a guaiac (+) stool
A. 10ml
32. Type of somatic stimulation resulting in pain
A. Stretching
B. Distention
C. Contraction
D. Inflammation
33. Cause of Hiccups except
A. Irritation of vagus nerve
B. Gastric distention
C. Cystitis
D. Alcohol ingestion
34. Difficulty in swallowing
A. Dysphagia
B. Odynophagia
C. Dyspepsia
12

D. Achalasia
35. Hypoactive bowel sounds except
A. Hypokalemia
B. Early small bowel obstruction
C. Inflammation
D. Ischemic bowel
36. All of the ff are true about Melena except
A. As little as 50ml of blood may produce this sign
B. Melena usually indicates upper GIT bleeding
C. Blood is the only substance proven capable of producing black stools
D. The tarry color is attributable to the production of acid hematin by the action of gastric acid on hemoglobin
37. Surgical intervention becomes likely in this type of pain
A. Visceral pain
B. Somatic pain
C. Psychosomatic pain
D. None
38. Almost always heralds intraabdominal disease but might not indicate the need for surgical therapy
A. Visceral pain
B. Somatic pain
C. Parietal pain
D. None
39. Dysphagia can be caused by the ff except
A. Acute Thyroiditis
B. Achalasia
C. ZenlierS Diverticulum
D. Cholecystitis
40. Initial test to diagnose Dysphagia
A. CXR
B. Barium swallow
C. Esophagoscopy
D. UGIS
41. Anorexia associated with generalized wasting and chronic disease
A. Cachexia
13

B. Carcinoma
C. Singultus
D. Dysphagia
42. Consequences of vomiting
A. Hypovolemia
B. Acid-Base disturbance
C. Paradoxical acidosis
D. All
43. Characteristic odor of flatus is due to
A. Oxygen
B. Nitrogen
C. Hydrogen Sulfide
D. Carbon Dioxide
44. Excessive flatulence results from the ff except
A. Disorders of intestinal motility
B. Decreased amount of swallowed air
C. Acrophagia
D. Altered metabolism of intestinal contents by bacteria
POST TEST SURGERY
(GIT)
1. Characteristics of adynamic ileus, except:
a. Commonly seen after a variety of abdominal operations
b. Most common ileus,
c. Gastric ileus occurs w/in 2 days
d. Described as tightly contracted bowel w/o propulsive activity
e. Colonic ileus lasts 3 4 days
2. Characteristic of visceral pain, except:
a. Characterized by A-delta fibers
b. Responsive to distention, traction
c. Innervated by autonomic C-type fibers
d. Poorly localized
14

3.

4.

5.
6.

7.

8.

9.

e. All of the above


Most common cause of GI bleeding in pediatric patient:
a. Ileus
b. strangulation
c. esophageal varices
d. obstruction
e. diverticulosis
In auscultation which condition presents w/ absent bowel sound, except:
a. narcotic overdose
b. mesenteric thrombosis
c. early small bowel obstruction
d. ileus
e. peritonitis
Significant weight loss: 10 15% w/in 3 4 months
Cardinal signs of obstruction, except:
a. Crampy abdominal pain
b. Nausea & vomiting
c. Obstipation
d. Crampy abdominal distention
e. Anorexia
Most common cause of small bowel obstruction
a. Malignancy
b. Diverticulosis
c. Volvulus
d. Strangulated hernia
e. Post operative adhesions (60 80%)
Most common etiology of acute constipation:
a. In elderly, prolapse
b. Due to laxative abuse
c. Congenital disease such as Hirschsprung Disease
d. Innervations rupture
e. Most often mechanical in orgigin like anal fissure & thrombosed hemorrhoids
Most common cause of upper GI bleeding: bleeding peptic ulcer disease
15

10. Characteristics of angiodysplastic lesion, except:


a. Degenerative
b. Lesion < 5mm diameter
c. Common in Cecum & right colon
d. Associated w/ other vascular lesion of viscera or skin
e. Increase w/ age

16

11. MANIFISTATIONS OF GIT DISEASES


12. 1 DYPHAGIA- PAIN IN SWALLOWING, (ODYNOPHAGIA)
13. 2 SYPTOM PATIENT/ SIGN DOCTOR
14. 3MOST COMMON ACUTE SURGICAL ABDOMINAL PAIN APPENDICITIS
15. 4 INITIAL TEST FOR DYSPHAGIA BARRIUM SWALLOW
16. 5 WHAT CAUSES HICKS UPS/SINULTUS- IRRITATION OF VAGUS NERVE
17. 6 DIFFERENCE BETWEEN ANOREXIA AND CACHEXIA ANOREXIA ABSENCE OF HUNGER/APPITITE,
CACHEXIA ANOREXIA OF CHRONIC DISEASE WASTING
18. 7 DIAGNOSIS OF ACUTE ABDOMINAL PAIN H & PE
19. 8 GAS AND BLOATING DUE TO INCREASE SENSITIVITY TO INTESTINAL STRETCH 1% OF GAS IS CAUSED
BY TRACE GASES THAT GIVE OULDER
20. 9 CONSTIPATION OF IMMOBILE PATIENT IN HOSPITAL- OGILVES SYNDROME
21. 10 CARDINAL SIGNS OF INTESTINAL OBSTRUCTION- N/V, ABDOM PAIN, DISTENTION, OBSTIPATION
22. 11 WHAT IS THE MC BACTERIA OF INTERABDOMINAL SEPSIS
23. 12 PHYSICAL EXAMINATION DISTINGUISH FAS FROM FLUID- PERCUSSION
24. 13 DISTINGUISH POINT TENDERNESS- PALPATE
25. 14 GATROPARESIS DIABETICORM- DM + CHROBNIC INSULIN DEPENDENCE + PNS + N/V
26. 15 INFECTIOUS DIAHREA LUMINAL SECREATION OF SOLUTE/WATER
27. 16 WHEN SEE HYPERACTIVE BOWEL SOUNDS- SMALL BOWEL OBSTRUCTION
28. 17 DIVIDES UPPER AND LOWER GIT LIGMENT TRES
29. 18 MOST COMMON IDEOLOGY OF SMALL BOWEL OBSTRUCTION- SURGICAL ADHESION
30. 19 WHICH OF THE FOLLOW IS LOWER GI BLEED
31. 20 WHICH OF THE FOLLOW IS UPPER GI BLEED- VARRICIES
32. 21 MOST COMMON OBSTRUCTION OF COLON TUMOR
33. 22 FIRST THING YOU DO IN EXAMING A PATIENT WITH ABDOMINAL PAIN FACIAL EXPRESSION
OBSERVATION
34. 23MOST COMMON MOTILITY DISORDER CAUSING DYSPLAGIA
35. APPENDIX
36. 1 1ST SYMPTON IN ACUTE APPENDICITIS
37. 2 PRIME SYMPTOM IN ACUTE APPENDICITIS
38. 3 LOCATION OF LYMPHOID TISSUE IN APPENDIX
39. 4 WHAT IS THE MOST COMMON EPIDIMOLOGY OF ACUTE APPENDICITIS
40. 5 WHAT ARE THE POSITION OF APPENDIX
17

41. 6 BLOOD SUPPLY OF APPENDIX


42. 7 CUTANOUS HYPERATHESIA IN ACUTE APPENDICITES- WHICH SIGN
43. 8 MOST IMPORTANT INFECTION IN APPENDICITES
44. 9 FINDINGS DIFFERATING UNITARY TRACT INFECTION FROM APPENDICITIS
45. 10 MANIFESTS AS LOWER ABDONINAL PAIN, HYPOVELIMIA, NON CLOTTING BLOOD IN CENTOCETISISWHAT IS IT
46. 11 ACUTE APPENDICITIS RLQ PAIN WHEN PALPAPATE LLQ WHICH SIGN
47. 12 STIMULATION OF SOMATIC NERVE WITH CAUSE WHICH ONE NAUSIA, VOMIT, ANOREXIA, FEVER
48. 13 M/C SITE CARCINOID- APPENDIX
49. 14 DIFFERENTIAL DIAGNOSIS ACUTE APPENDICITIS DEPENDS ON EITHER ATOMC LOCATION OF APPENDIX
STAGE OF PROCESS OR BOTH
50. 15 MOST COMMON ERRONOUS PEROP DIAGNOSIS AS ACUTE APPENDICITIS

18

19

20

Appendix
1. Which statement is true regarding acute appendicitis during pregnancy
A. It is the most common cause of acute abdomen in women during pregnancy
B. It should be treated with antibiotics initially to avoid surgery
C. It may present with right upper quadrant or right flank tenderness & pain
D. A&C
E. All
2. A 26 year old female was seen at the E.R with RLQ pain and tenderness. Gynecologic history revealed she is at the midpoint of
the menstrual cycle. She is also febrile(38.5) with mild diarrhea and 2 episodes of vomiting. The WBC count is 12,000mm3.
which is the most likely diagnosis
A. PID
B. AGE
C. Acute AP
D. Ruptured ovarian cyst
E. Mittelschrnerz
3. Appropriate courses of action in the above patient include the following except
A. Appendectomy via Rocky-Davis incision
B. Laparoscopy
C. Ultrasound examination
D. Observation and antibiotics
E. None
4. Differential diagnosis of acute appendicitis in the male except
A. Acute mesenteric adenitis
B. Gastroenteritis
C. Incarcerated inguinal hernia
D. Diverticulitis
E. None
5. During laparotomy for a presumed acute appendicitis, a firm yellow bulbous mass was noted at the tip of the appendix. This is
most likely a
A. Mucocoele
B. Carcinoid
21

C. Meckels Diverticulum
D. Fecalith
6. The appropriate management of appendicial carcinoid 2cm in size is
A. Right hemicolectomy
B. Chemotherapy
C. Appendectomy
D. No Tx necessary
7. True statement regarding carcinoid of the appendix except
A. Most common location of gastrointestinal carcinoid
B. The base of the appendix is most commonly involved
C. Usually an incidental finding
D. Malignant potential is related to size of the tumor
8. With regards to anatomy of the appendix, which statement is true
A. The position of the tip of the appendix may influence the presenting symptom
B. In the adult the base is usually retrocecal in location
C. The taenia coli may be used to locate the appendix
D. All
9. Which of the following statement regarding function of the appendix is true
A. Protects against the development of colon CA because of its immunologic function
B. It is the major source of antibody producing lymphocytes
C. Together with the ileum & tonsils, it contributes to the secretory immune system
D. It is a vestigial organ with no known fxn
E. All
10. Which of the following statement regarding pathogenesis of acute appendicitis is true
A. Luminal obstruction is the most important factor in its development
B. Lymphoid hyperplasia may cause acute appendicitis
C. Fecalith cause acute AP in majority of cases
D. All
11. pelvic appendicitis is frequently associated with which of the following signs
A. Tenderness at Mcburneys point
B. Psoas sign
C. Obturator sign
D. Rovsings sign
22

E. Dumphys sign
12. The typical pxn with acute appendicitis will describe the onset of symptoms as follows
A. Periumbilical pain, nausea/vomiting, RLQ pain & tenderness, fever
13. Correct statement regarding S/Sx of acute appendicitis except
A. Vomiting usually precedes pain
B. Anorexia is a constant symptoms
C. Pain is initially felt at the periumbilical crea
D. Obstipation or diarrhea may occur
E. None
14. Most reliable PE finding in acute appendicitis
A. Psoas sign
B. Rectal tenderness
C. Localized RLQ tenderness
D. Obturator sign
E. All are equally reliable
15. Correct statement regarding diagnosis of acute appendicitis
A. Presence of WBC & RBC can be found in the urine of patient with acute appendicitis
B. A normal total & differential WBC count correlated with the degree of appendicial abnormality
C. The presence of bacteria in the urine does not exclude the diagnosis of acute AP
D. A & C
E. All
16. True statement regarding appendicitis in children except
A. Associated with high rupture rate due to delay in diagnosis
B. Rupture results in localized periumbilicial abscess
C. Compared to the adult, rupture is frequently followed by diffuse peritonitis
D. Walling-off process is less efficient in children due to incompletely developed omentum
E. None
17. True statement regarding appendicitis in the elderly except
A. It may mimic intestinal obstruction
B. Symptoms and PE findings are fairly constant
C. Associated with high rate of perforation
D. It may require right hemicolectomy
E. None
23

18. Elicited with inflammation of a pelvic appendicitis


A. Obturator sign
19. RLQ pain & tenderness which intensifies on coughing or movement
A. Dunphys sign
20. RLQ pain induced by palpation of the left lower quadrant suggestive of inflammatory process
A. Rovsings sign

24