PMC Certificate Examination

BASIC QUESTIONS:-

Q1- Toxoid is:

A- Inactivated endotoxin.

B- Usually given intravenously.

C- Inactivated exotoxin.

D- Usually given after ten days of injury.

E- None of the above.

Q2-All the following can be lost after median nerve injury except:
A- Adduction of the thumb.

B- Oponnus of the thumb.

C- Abduction of the thumb.

D- Loss of sensation in the lateral 3.5 of the hand.

E- Atrophy of the thenor muscles.

Q3-The normal number of neutrophile in the C.S.F analysis is:
A- 1

B- 2

C- 3

D- 5

E- None of the above.

Q4- The principle extra cellular buffer is:
A- Phosphate.

B- Proteins.

C- Hemoglobin.

D- Bicarbonate.

E- Calcium.
Q5- The most common primary malignant tumor of bone is:

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 A- Malignant giant cell tumor.

B- Osteosarcoma.

C- Chondrosarcoma.

D- Osteochondrosarcoma.

E- None of the above.

Q6- 20-32 years old otherwise healthy male is scheduled to undergo repair of a left
inguinal hernia, which of the following screening laboratory tests should be
obtained prior the operation:
A- Electro cardiogram.

B- Chest radiography.

C- Bleeding time.

D- Partial thrombo plastin time.

E- No screening tests are necessary.

Q7- Skeletal muscle breakdown produces predominantly liberation of which two
amino acids?
A- Lysine & tyrosine.

B- Tyrosine & alanine.

C- Alanine & glutamine.

D- Glutamine & arginine.

E- Arginine & lysine.

Q8- The characteristic changes that follow a major operation or moderate to severe
injury do not include the following:
A- Hypermetabolism.

B- Fever.

C- Tachypnea.

D- Hyperphagia.

E- Negative nitrogen balance.

Q9- Which of the following is not associated with increased likelihood of infection
after major elective surgery?
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 A- Age over 70 years.

B- Chronic malnutrition.

C- Controlled diabetes mellitus.

D- Long-term steroid use.

E- Infection at a remote body site.

Q10- A 62-year-old man cuts his hand on a broken soft-drink bottle at a family
picnic. He has a history of a full tetanus immunization as a child, and his last
tetanus toxoid booster was 14 years ago. The proper treatment for him is
appropriate local wound care and:
A- Tetanus toxoid injection.

B- Tetanus immune globulin (TIG) infiltrated into the tissues around the wound.

C- Tetanus toxoid and scheduling for additional boosters 1 and 6 months later.

D- Prophylactic antibiotics started immediately and Tetanus toxoid.

E- Prophylactic antibiotics only to be started immediately.

Q11- Regarding cardiovascular disease in the surgical patient, all true EXEPT:
A- Following a myocardial infarct elective surgery should be deferred for over 6 months.

B- 60% of post-operative re-infarctions are clinically silent.

C- The mortality of a post-operative myocardial infarct is about 40%.

D- The risk of a post-operative infarct is reduced in hypertensive patients.

E- Left ventricular ejection fraction is a useful marker of cardiovascular function.

Q12- The following are clinical features of a large pulmonary embolism EXCEPT:
A- Pleuritic chest pain.

B- Haemoptysis.

C- Low grade pyrexia.

D- Tachycardia.

E- Collapsed neck veins.

Q13- Regarding the anatomy of the inguinal canal, all true EXCEPT:
A- The internal ring lies midway between the pubic tubercle and anterior superior iliac.

B- The internal ring lies medial to the inferior epigastric vessels.

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 C- The external oblique aponeurosis forms the anterior boundary.

D- The inguinal ligament forms the inferior boundary.

E- The conjoint tendon forms the medial part of the posterior wall.
Q14- Regarding clostridium tetani, all true EXCEPT:

A- Is a gram-positive rod

B- Is sensitive to penicillin

C- Is widely prevalent in both soil and the environment

D- Releases a heat-resistant endotoxin

E- Clinical manifestations include risus sardonicus (facial muscles spasm) &

opisthotonos (back muscles spasm)

Q15- While being evaluated for transfer to a rehabilitation facility 5 days following a
total knee Replacement, a 74-year-old man is noted to have a sinus
tachycardia of 120 beats per minute a blood pressure of 130/85 mmHg, and
unlabored respiratory rate of 30, with an oxygen saturation of 88% on room
air. Which of the following is true?E
A- He should be transferred with a 2L/min 02 nasal cannula.

B- He should receive a bolus of2500,000 units of urokinase

C- A bolus of 0.25mg of digoxin should be administered

D- Broad spectrum antibiotics should be started for pneumonia

E- He should be given a bolus of intravenous heparin and a ventilation/perfusion (v/Q) scan

should be obtained urgently.

Q16- The most common fluid disorder in the surgical patient is:
A- Extra cellular fluid volume deficit.

B- Hyperkalamia.
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 C- Hyponatremia.

D- Metabolic acidosis.

E- Metabolic alkalosis
Q17- The major cause of impaired wound healing:
A- Anemia.

B- Diabetes mellitus.

C- Local tissue infection.

D- Malnutrition.

E- Steroide use.
Q18- All of the following symptoms and signs may occur with sever visceral pain
EXCEPT:
A- Hypotension.

B- Muscular rigidity.

C- Neusea.

D- Sweating.

E- Tachycardia.
Q19- Chole cysto kinin has all of the following except:
A- It inhibits bowel motility.

B- It produces relaxation of the sphincter of odds.

C- It simulates gall Bladder contractility.

D- It simulates release of insulin.

E- It simulates secretion of enzymes by pancreatic acinar.

Q20- Which statement is wrong in disseminated intravascular coagulation

A-Can be easily controlled by heparin treatment.

B- Is an imbalance between coagulation and fibrinolysis.

C- Typically seen in patients with trauma, septic shock and hypoperfusion.

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 D- May lead to uncontrollable bleeding.

E- Is tendency for microcirculation thrombosis and external bleeding.

Q21- A patient on prolonged total parental alimentation develops diarrhea,
depression, alopecia and perioral and periorbital dermatitis. Which of the
following trace elements is most needed for treatment?
A- Iodine.

B- Zinc.

C- Selenium.

D- Tin.

E- Cobalt
Q22- Acute compartment syndrome is characterized by all of the following
EXCEPT:
A- Pain on stretching the muscles.

B- Absent arterial pulsation’s early in the disease [since the first hour].

C- The presence of paresthesia or anesthesia.

D- The presence of paresis or paralysis.

E- Can result after revascularisation of an acutly ischemic limb.

Q23- The risk factors associated with development of acute renal dysfunction after
angiography include all EXCEPT:
A- Amount of contrast material injected.

B- Age of the patient.

C- Site of injection.

D- Presence of congestive heart failure.

Q24- Radiotherapy is not effective in which of the following sites of esophageal cancer:
A- Post cricoid.

B- Upper third.

C- Middle third.
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 D- Lower third.

E- Where right bronchus crosses the oesophagus.

Q25- The most persistent increase in plasma volume is achieved by giving one of the
following i.v. fluids.
A- Glucose in distilled water

B- Normal saline

C- High molecular weight dextran

D- Ringer's lactate solution

E- Packed red cells

Q26- Bleeding after massive blood transfusion of old bank blood is caused by:
A- Citrate poisoning

B- High potassium level

C- Excessive serotonin release

D- Thrombocytopenia

E- Inactivity of intracellular ATP in red blood cells

Q27- The primary objective of wound debridement after trauma is to
A- Remove contaminating bacteria

B- Excise skin to promote drainage

C- Permit immediate skin closure

D- Obviate need for antibiotics

E- Remove non-viable tissue

Q28- All statements regarding branchial cyst are true, EXCEPT ONE:
A- Is a swelling in the superior part of the anterior triangle of the neck

B- Usually forms a discharging sinus

C- Should be excised for cosmetic reasons and to prevent infection

D- Contains opaque watery or milky fluid

E- Do not move when the tongue is protruded

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Q29- Nephrectomy following kidney trauma is usually not performed unless
A- Fluid replacement is complete

B- Cystoscopy has been performed

C- Antibiotics have been given

D- Abdomen has been explored

E- Adequate contralateral function has been confirmed

Q30- Urinary bladder stones are:
A- Commonly developing in aseptic urine

B- Usually calculi of infectious origin

C- Commonly radiolucent

D- More common in women

E- Often dissolved by acidifying the urine

Q31- Following a fracture, avascular necrosis is common in:
A- Scaphoid bone

B- Hamate bone

C- The patella

D- Humeral head

E- Fibula head.

Q32-The most common source of osteolytic metastatic bone tumour is:

A- Squamous cell carcinoma of the leg

B- Lung cancer

C- Prostatic carcinoma

D- Giant cell tumour of bone

E- Testicular terratoma

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Q33-Which of the following primary conditions is likely to cause swelling of the
cheek?
A- chronic sinusitis

B- nasal allergy

C- foreign body in nose

D. periodontal abcess

E. idiopathic trigeminal neuralgia

Q34- Strangulated contents of hernial sacs
A- Are always accompanied by intestinal obstruction

B- Are more common in direct than indirect inguinal herniae

C- Are usually reducable

D- Produce local pain and tenderness

E- Are sterile
Q35- 24hours after colon resection,urine output in a 70-year old man is 10ml/h. His
Na is 138mEq/L ; K is 6mEq/L ; Cl is 100mEq ; bicarbonate is 14 mEq/L.His
metabolic abnormality is characterized by which of the following?
A- Abdominal distension

B- Peaked T waves

C- Narrow QRS complex

D- Cardiac arrest in systole

E- J wave or Osborne wave

Q36- A 60-year old woman is oliguric after undergoing cholecystectomy.She weighs
65 kg, and her laboratory values are:Hb,10.5 mg/dL,WBC,12000/mm3
serumNa,138mEq/L; K,4mEq/L; Cl,100mEq/L;Bicarbonate,28mEq/L;serum
createnine,1.0mg/dL;BUN,20mg/dL.The anion gap is which of the following?
A- 10

B- 18

C- 30

D- 38
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 E- 42
Q37-A 55-year old man with Crhon’s disease had undergone resection of small
bowel and anastamosis.10 days later, he is found to have bilious drainage of
1L/day from the drains. He is started on TPN.4days later, his (ABG’s) are:
pH, 7.25 ; PO 2 ,98mmHg ; and PCO 2 ,40mmHg.His anion gap is 10.The most
likely cause is which of the following?
A- Diabetic ketoacidosis

B- Renal failure

C- Hypovolemic shock

D- Small-bowel fistula

E- Uncompensated metabolic alkalosis.

Q38- A 24-year old man who is admitted to the intensive care unit following severe
head injury develops seizures on the fourth day of admission. His urine output
is 500ml over 24h, Na, 115mEq/L; and serum and urine osmolality are 250 and
800 mOsm, respectively. The metabolic abnormality is due to which of the
following?
A- Administration of 5% D/W and 0.33 normal saline

B- Syndrome of inappropriate secretion of antidiuretic hormone

C- Decreased antidiuretic hormone secretion

D- Nasogastric suction

E- Renal insufficiency

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Q39- A 30 year old man who weighs 60 kg has the following laboratory values:
hemoglobin, 10g/dL ; serum sodium,120 mEq/L; serum potassium,4 mEq /L;
serum chloride,90 mEq/L; and serum CO 2 content, 30 mEq/L. What is his
sodium deficit approximately?
A- 20 mEq

B- 200 mEq

C- 400 mEq

D- 720 mEq

E- 120 mEq
Q40- A 30 year-old man with a history of Crohn’s disease of the small bowel is
admitted with enterocutaneous fistula. The daily output from the fistula is 2L.
The approximate composition of the fluids in mEq/L is which of the following?
Na K Cl HCO 3

A- 10 26 10 30

B- 60 10 130 0

C- 140 5 104 30

D- 140 5 75 115

E- 60 30 40 40
Questions 41 and 42
A 70 year old man has undergone anterior resection for carcinoma of the rectum. He
is extubated in the operating room (OR). In the recovery room, he is found to be
restless with a heart rate of 136 bpm and a blood pressure of 144/80 mmHg. ABG
analysis on room air reveals pH, 7.24;P CO2. 60 mm Hg; P O2 , 54; HCO 3, 25 mEq/L;
and SaO 2 , 90% .
Q41- The physiologic statues can best be described as which of the following?
A- Respiratory alkalosis

B- Respiratory acidosis

C- Metabolic acidosis

D- Metabolic alkalosis
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 E- Combined respiratory and metabolic acidosis.
Q42- Appropriate management for this patient should be which of the following?
A- To administer 40% oxygen by mask

B- Morphine,2 ,mg IV

C- Ringer’s lactate,250 mL over 1 hour

D- Intubation and ventilatory support

E- Deep breathing and coughing

Questions 43 and 44 and 45
A 27 year old man is involved in a car crash while traveling in excess of 130 km/h.
He sustains an intraabdominal injury and a fracture of the femur.The blood
pressure is 60/40 mmHg,and the hematocrit is 16%.
Q43- Which physiologic changes will ensue?
A- Peripheral vasodilation

B- Inhibition of sympathetic tone

C- Temperature rise to 1030 F

D- Eosinophilia

E- Lactic acidosis
Q44-There is likely to be a proportionately greater increase in blood flow to which of
the following?
A- Kidneys

B- Liver

C- Heart

D- Skin

E- Thyroid gland
Q45- Initial resuscitation is best done by administration of which of the following?
A- D 5 W

B- D 5 W and 0.45% normal saline

C- Ringer’s lactate solution

D- 5% plasma protein solution

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 E- 5% hydroxyethyl starch solution
Questions 46 and 47 and 48 and 49
A 48 year old man with severe vomiting as a result of gastric outlet obstruction is
admitted to the hospital .There is marked dehydration,with urine output 20 mL/h.
and the hematocrit is 48%.
Q46-Clinical confirmation of pyloric obstruction is most readily established by
which of the following?
A- Observation of peristalsis from left to right

B- Observation of peristalsis from right to left

C- Percussion of the upper abdomen

D- Succussion splash

E- Auscultation of the upper left abdomen

Q47- What is the predominant metabolic abnormality?
A- Aspiration pneumonia with respiratory alkalosis

B- Hypochloremic alkalosis

C- Salt-losing enteropathy

D- Intrinsic renal disease

E- Metabolic acidosis
Q48- Initial treatment for this patient should include which of the following?
A- Administration of 10% dextrose D 10 W in one-third saline solution intravenously.

B- Antiemetic

C- Hemodialysis to correct azotemia

D-Saline fluid replacement with appropriate potassium administration

E-Ringer’s lactate solution.

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Q49- Severe metabolic abnormality of this patient fails to respond to standard
therapy. His metabolic abnormality can be corrected by infusing which of the
following:
A- Normal saline

B- Ringer’s lactate solution

C- Hypertonic saline

D- 0.1 N hydrochloric acid

E- 1.0 N hydrochloric acid

Q50- Abduction of the vocal cords results from contraction of the
A- Crico-thyroid muscles

B- Posterior crico-arytenoid muscles

C- Vocalis muscles

D- Thyro-ary-epiglottic muscles

E- Lateral crico-arytenoid and transverse arytenoids muscles

Q51- The rectum
A- Is devoid of peritoneum.

B- Is surrounded by peritoneum.

C- Has peritoneum on its lateral surfaces for its upper two- thirds, and on its anterior

surface for its upper one-third.

D- Has pritoneum on its anterior surface for its upper two-thirds, and on its lateral surfaces

for its upper one-third.

E- Has peritoneum on its anterior surface only.

Q52- The umbilicus
A- Lies near the to the xiphoid than to the pubis

B- Derives its cutaneous innervation from the eleventh thoracic nerve

C- Transmits, during development, the umbilical cord two arteries and two veins

D- Usually lies at about the level between the third and fourth lumbar vertebra

E- Emberiologicall, may transmit urine but never bowel contents

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Q53- The superficial perineal pouch
A-Is limited inferiorly by the urogenital diaphragm

B-Is not continuous with the space in the scrotum occupied by the testes

C-Has a membranous covering which provides a fascial sheath around the penis

D-Is traversedby the urethera in the male but not the urethera and vagina in the female

E-In the female, the greater vestibular glands are situated outside this pouch
Q54- The tongue
A-Has a foramen caecum at the base of the frenulum

B-Is separated from the epiglottis by the valleculae on each side of the midline

C-Has 7-12 circumvallate papillae situated behind the sulcus terminalis

D-Is attached to the hyoid bone by the genioglossus muscle

E-Is supplied only by hypoglossal nerve

Q55- Hypovolaemic shock is characterized by:
A- A low central venous pressure, low cardiac output, low peripheral resistance

B- A high central venous pressure, high cardiac output, low peripheral resistance

C- A low central venoys pressure, low cardiac output, high periphera resistance

D-A low central venous pressure, high cardiac output, high peripheral resistance

E- A high central venous pressure, low cardiac output, low peripheral resistance
Q56- An oxygen debt is
A- The amount of oxygen in excess of the resting metabolic needs that must be consumed

after completion of exercise

B- Build up because the pulmonary capillaries limit the uptake of Oxygen at high rates of

oxygen consumption

C-related to the fact that skeletal muscle cannot function temporarily in the absence of

oxygen.

D- Associated with a decrease in blood lactate

E- Associated with alkalosis

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Q57-Pulmonary embolism may be a complication of
A-Prolonged bed rest

B- A surgical operation

C- Vitamine K deficiency

D- Oral contraceptive therapy

E- Antithrombin III deficiency

Q58-Which of the following statements regarding potassium metabolism is NOT
True?
A-Potassium deficiency commonly results from thiazide diuretic theraoy

the normal compensation for potassium deficiency is a metabolic

B- Extracellular acidosis

C- Aldosterone increases urinary potassium loss

D- Hyperkalaemia causes bradycardia and loss of P waves on the ECG

E- Hypokalaemia aggrevates the cardiac effects of digitalis toxicity

Q59- Cutaneous pain
A- Is due to overstimulation of receptors serving other sensory modalities

B- Cannot be elicited more readily if the tissue has recently been injured

C- Is due to exitation of receptors by pain-producing chemical substances in the injured

tissue

D- Shows marked adaptation, i. e. decrease in severity in response to a constant stimulus

E- Is conducted through the medial spinothalamic tract

Q60- Which of the following is NOT associated with hyperthyroidism?
A-Increase size of the thyroid gland

B-Increased amount of colloid in thyroid follicle

C-Increased height of epithelium of the thyroid follicle

D-Increased vascularity of the thyroid gland

E-Increased uptake of iodine by the thyroid gland.

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Q61- Sarcomata may show all of the following EXCEPT:
A- Production of myxomatous tissue

B- Production of collagen

C- Spindle shaped cells

D- Signet ring cells

E- Blood stream metastasis

Q62- Anaphylaxis is characterized by all of the following EXCEPT:
A-Is a reaction either local or general, frequently occurs within five minutes

B-Causes an urticarial eruption

C-Is produced by IgA antibody

D-Causes eosinophilia

E-Causes degranulation of basophils and mast cells

Q63- Autoimmunity is characterized by the following EXCEPT:
A-Occurs because of a breakdown in the ability of the body to distinguish between self and

non self

B-Is involved in some forms of orchitis

C-Is involved in formation of cryo globulin

D-Is important in the pathogenesis of lupus erytheromatosus

E-Does not result in immune complex disease

Q64- Pseudomembranous enterocolitis is caused by the following organisms:
A- Clostridium sporogenes

B- Clostridium defficile

C- Streptococcus faecalis

D- Penicillin sensitive staphylocci

E- Pseudomonas aeruginos

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Q65- The following are correct contents of common crystalloid solutions.
A- NaCl 0.9% contains 154mmol of sodium per litre

B- NaCl 0.9% contains 72 mmol of chloride per litre

C- Glucose 5% contains 20 mmol of potassium per litre

D- Hartmann’s contains 40 mmol of potassium per litre

E- Hartmann’s contains 150 kCal per litre

Q66- Local anaesthesia, all are incorrect EXCEPT:
A- Only affects sensory nerve fibres

B- Is very effective for incision and drainage of cutaneous abscesses

C- Must be injected into the tissues to become effective

D- In high doses can cause convulsions and bradycardia

E- May not be used in the region of an end-artery

Q67- In general anaesthesia, all are incorrect EXCEPT:
A- Pulse oximetry is used routinely to record the heart rate and oxygen saturation

B- Patients require mechanical ventilation for the operative period

C- Preoperative starvation ensures that the stomach is empty

D- Bradycardia is treated with neostigmine

E- Opioids do not cause direct myocardial depression

Q68- Atelectasis, all are correct EXCEPT:
A- May impair gas exchange

B- May predispose to chest infection

C- Can be prevented by prophylactic treatment with antibiotics

D- Is common cause of an early postoperative fever

E- May necessitate fibreoptic bronchoscopy to extract mucus plugs

Q69- Postoperative fluid management of the surgical patient should:
A- Include administration of 40-60 mmol of potassium in the first 24h

B- Account for insensible losses of up to 1500 ml if the patient is septic

C- Include packed red blood cells if the haematocrit falls below 40%

D- Aim to provide at least 1000 calories for the first three postoperative days
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 E- Be increased if the central venous pressure falls below 8 cm H 2 O
Q70- TPN, all correct EXCEPT:
A- Most commonly is administered via large central veins

B- Is indicated in approx 25% of patients in hospital requiring nutritional support

C- Is indicated for all patients with paralytic ileus

D- Should be administered using an infusion pump

E- May include hepatocyte dysfunction

Q71- Features of the systemic inflammatory response syndrome (SIRS) should not
include:
A- Temp>38.4 ºc

B- Temp<35.6ºc

C- WCC<4 cells/ml

D- Respiratory rate>20/min

E- PaCo2>32 mmHg
Q72- The following are general effects of burn injury EXCEPT:
A- Increased metabolic

B- Impaired immune function

C- Hypernatraemia

D- Hypoalbuminaemia

E- Impairment of gut barrier function

Q73- In Acute renal failure, all are incorrect EXCEPT:
A- Reduced systolic blood pressure

B- Hyperglycaemia

C- Hypernatraemia

D- An increased prothrombin time

E- Encephalopathy

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Q74- With regard to a cancer screening test
A- The sensitivity of the test defines the proportion of those with cancer in whom a positive

test has been recorded.

B- The specificity is the reciprocal of the false negative rate.

C- The specificity is the proportion of all those without cancer who are correctly classified

as negative by the screening test.

D- Sensitivity and specificity are inversely related.

E- The positive predictive value represents the proportion of those with a positive

test who are subsequently proven to have cancer.

Q75- Concerning consent for surgery
A- In British law, anyone over the age of 16 years is regarded as potentially able to give

consent.

B- If a patient is mentally incapable of giving consent (e.g. due to senile dementia), consent can

be given by a first degree relative.

C- If a patient is physically incapable of giving consent (e.g. an unconscious patient) consent

can be given by a first degree relative.

D- Consent for an operation generally applies to all aspects and producers related to the

operation.

E- If a parent refuses essential treatment for a child, the doctor must adhere to this and

cannot in any way undertake treatment of the child.

Q76- The following are examples of inflammatory mediators EXCEPT:
A- Platelet-Derived Growth Factor (PDGF)

B- Tumour Necrosis Factor (TNF)

C- Interleukin 6

D- Erythropoietin

E- Leucotriene B4

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Q77- Which of the following statement is true
A- Pulse oximeters are not accurate in patients with haemoglobin less than 5g/dl.

B- Approximately 60% of the body’s excess iron is stored in the bone marrow.

C- Red blood calls for transfusion can be stored for up to 90 days at 4c.

D- Disseminated intravascular coagulation (DIC) is characterized by an increase in the

platelet count and an increase in fibrin degradation products.

E- Disseminated intravascular coagulation (DIC) results in an increased clotting

tendency and an increased risk of venous thrombosis.

Q78- Aetiological factors associated with peptic ulceration include EXCEPT:
A- Head injury

B- Helicobacter pylori infection

C- Gastrinoma

D- Bile reflux

E- High intragastric pH
Q79- The Glasgow coma scale, all are incorrect EXCEPT:
A- Measures 4 patient responses: eye opening, verbal response, motor response and papillary

reflexes.

B- Defines coma as a response <8.

C- Is used principally as a one off test to rapidly document the level of

consciousness.

D- If the less than 6, represents an indication for exploratory burrholes.

E- May be used to diagnose an intracerebral haematoma.

Q80- Insulinoma, all correct EXCEPT:
A- Are usually benign tumours of the pancreas.

B- Often present with Whipple’s triad.

C- May not be identified and localized prior to surgical exploration.

D- Can be treated by enucleation.

E- May be part of the Zollinger-Ellison syndrome.

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