Egyptian Medical Licensing Examination (EMLE) · Clinical Medicine and Surgery

General Surgery and Surgical Emergencies

66 practice questions, each with the answer and an explanation.

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All 66 questions

  1. A 22-year-old male presents with 12 hours of periumbilical pain that has migrated to the right lower quadrant, associated with nausea, low-grade fever, and rebound tenderness at McBurney's point. What…
  2. A 48-year-old female presents with severe colicky right upper quadrant pain radiating to the right scapula following a fatty meal. Abdominal ultrasound shows gallstones, gallbladder wall thickening of…
  3. A 55-year-old male presents with severe epigastric pain radiating directly to the back, vomiting, and a serum lipase level of 1,800 U/L (reference < 60 U/L). What is the cornerstone of early managemen…
  4. A 30-year-old male involved in a high-speed motor vehicle collision arrives hypotensive (BP 75/40 mmHg) and tachycardic (HR 135 bpm). Trachea is shifted to the left, and breath sounds are absent on th…
  5. Which classical sign of cardiac tamponade is defined by the triad of hypotension, jugular venous distention, and muffled heart sounds?
  6. A 65-year-old male with previous abdominal surgeries presents with colicky abdominal pain, abdominal distention, bilious vomiting, and obstipation. Abdominal X-ray demonstrates dilated small bowel loo…
  7. An 80-year-old nursing home resident presents with marked abdominal distention, obstipation, and cramping lower abdominal pain. Plain radiograph reveals a dilated, ahaustral, U-shaped colonic loop ari…
  8. A 40-year-old male presents with bright red blood per rectum during defecation and a painful perianal lump that developed suddenly after straining. Examination reveals a tense, bluish, tender mass cov…
  9. A 70-year-old male smoker presents with painless gross hematuria. Physical examination is unremarkable. Renal ultrasound and urine culture are negative for infection. What is the essential next diagno…
  10. Which anatomical triangle bounded by the cystic duct, common hepatic duct, and inferior margin of the liver contains the cystic artery and is dissected during cholecystectomy?
  11. A 75-year-old female presents with sudden onset of severe abdominal pain out of proportion to physical examination findings. She has a history of atrial fibrillation. Abdominal examination reveals mil…
  12. A 62-year-old female presents with a painless, hard, irregular 2.5 cm breast mass in the upper outer quadrant with overlying skin dimpling and axillary lymphadenopathy. What is the standard diagnostic…
  13. A 25-year-old male presents with acute severe scrotal pain of 2 hours duration. On physical examination, the left testis is swollen, exquisitely tender, and positioned high in the hemiscrotum in a tra…
  14. What is the most common histological type of thyroid carcinoma, characterized by psammoma bodies and 'Orphan Annie eye' nuclear inclusions?
  15. A 35-year-old male presents with a reducible groin bulge that emerges medial to the inferior epigastric vessels through Hesselbach's triangle. What type of hernia is present?
  16. A 50-year-old male with severe acute pancreatitis develops tachypnea, severe hypoxemia (), and bilateral diffuse alveolar infiltrates on chest radiograph without evidenc…
  17. A 32-year-old female presents with a painless lump in the right groin located inferior to the inguinal ligament and medial to the femoral vein. She is at high risk of strangulation. What type of herni…
  18. Which classification system grades burn surface area by assigning 9% to the head and neck, 9% to each upper limb, 18% to the anterior torso, 18% to the posterior torso, and 18% to each lower limb in a…
  19. A 28-year-old male sustains deep second-degree burns covering 30% of his total body surface area (TBSA). He weighs 70 kg. According to the Parkland formula (…
  20. A 45-year-old male undergoes open right hemicolectomy for cecal adenocarcinoma. On postoperative day 5, his midline surgical incision discharges a large amount of serosanguinous fluid, and wound separ…
  21. Which scoring system uses eyes open, verbal response, and motor response to quantify acute neurological impairment following traumatic brain injury?
  22. A 68-year-old female presents with severe crampy left lower quadrant abdominal pain, fever (38.8 C), and leukocytosis. Contrast CT scan of the abdomen reveals focal sigmoid colonic wall thickening, pe…
  23. A 50-year-old male with jaundice, dark urine, and pale stools undergoes abdominal ultrasound demonstrating marked dilation of the common bile duct and intrahepatic ducts with a distended, non-tender g…
  24. Which vessel is primarily responsible for the rapid arterial blood supply of the cystic duct and gallbladder bed during laparoscopic dissection?
  25. A 24-year-old male is stabbed in the right upper thigh. On arrival, there is active pulsatile arterial bleeding and expanding hematoma. What is the immediate initial step to control hemorrhage?
  26. What is the most common cause of early postoperative fever occurring within the first 24 to 48 hours after major surgery?
  27. A 28-year-old trauma patient arrives with severe dyspnea, trachea deviated to the right, absent breath sounds on the left, and blood pressure . What is the immediate life-saving int…
  28. A 35-year-old male presents with right lower quadrant abdominal pain, anorexia, and localized tenderness at McBurney point. What is the most definitive diagnostic test in adult males when clinical dia…
  29. A 62-year-old male with cirrhosis presents with massive hematemesis. Pulse is , BP . Along with fluid resuscitation, what immediate pharmacotherapy should be started…
  30. A 70-year-old female presents with acute pain, pallor, pulselessness, and paresthesia in the left lower leg of 2 hours duration. What is the diagnosis?
  31. A 50-year-old male sustains deep partial-thickness burns covering the entire anterior torso () and both anterior thighs (). Under the Parkland formula, what volume of Ringer's lactate is ad…
  32. A 67 kg adult needs a minimum urine output of 0.5 mL/kg/h. What is the minimum expected urine volume over 6 hours?
  33. A 74 kg adult needs a minimum urine output of 0.5 mL/kg/h. What is the minimum expected urine volume over 4 hours?
  34. A 58 kg adult needs a minimum urine output of 0.5 mL/kg/h. What is the minimum expected urine volume over 6 hours?
  35. A 60 kg adult has burns over 20% of the body surface. Using the Parkland formula (4 mL × kg × %TBSA), how much fluid is given in the first 8 hours?
  36. Periumbilical pain that moves to the right iliac fossa with anorexia and fever suggests which diagnosis?
  37. A patient weighing 90 kg is to receive an infusion at 5 mcg/kg/min. The solution contains 1000 mcg/mL. What infusion rate is needed in mL/h?
  38. A 50 kg adult has burns over 30% of the body surface. Using the Parkland formula (4 mL × kg × %TBSA), how much fluid is given in the first 8 hours?
  39. In the primary survey of a trauma patient, which letter of ABCDE follows Airway?
  40. A 70 kg adult has burns over 10% of the body surface. Using the Parkland formula (4 mL × kg × %TBSA), how much fluid is given in the first 8 hours?
  41. A hernia that cannot be reduced and has become tender with vomiting and a red overlying skin is called what?
  42. Pain out of proportion to injury and pain on passive stretching after a tibial fracture suggest what?
  43. A 88 kg adult needs a minimum urine output of 0.5 mL/kg/h. What is the minimum expected urine volume over 4 hours?
  44. A patient weighs 67 kg and is 1.75 m tall. According to the WHO classification (underweight below 18.5, normal 18.5–24.9, overweight 25–29.9, obese 30 or more), which category is this?
  45. A 56 kg adult needs a minimum urine output of 0.5 mL/kg/h. What is the minimum expected urine volume over 4 hours?
  46. A 93 kg adult needs a minimum urine output of 0.5 mL/kg/h. What is the minimum expected urine volume over 4 hours?
  47. A 3-year-old boy suddenly develops severe testicular pain and a high-riding testis with an absent cremasteric reflex. What is the next step?
  48. Free air under the diaphragm on an erect chest X-ray indicates what?
  49. A 50 kg adult has burns over 20% of the body surface. Using the Parkland formula (4 mL × kg × %TBSA), how much fluid is given in the first 8 hours?
  50. A patient weighing 80 kg is to receive an infusion at 2 mcg/kg/min. The solution contains 1600 mcg/mL. What infusion rate is needed in mL/h?
  51. A patient weighing 70 kg is to receive an infusion at 5 mcg/kg/min. The solution contains 2000 mcg/mL. What infusion rate is needed in mL/h?
  52. A patient weighs 50 kg and is 1.5 m tall. According to the WHO classification (underweight below 18.5, normal 18.5–24.9, overweight 25–29.9, obese 30 or more), which category is this?
  53. A 70 kg adult has burns over 50% of the body surface. Using the Parkland formula (4 mL × kg × %TBSA), how much fluid is given in the first 8 hours?
  54. A 50 kg adult has burns over 50% of the body surface. Using the Parkland formula (4 mL × kg × %TBSA), how much fluid is given in the first 8 hours?
  55. A patient weighing 90 kg is to receive an infusion at 10 mcg/kg/min. The solution contains 1200 mcg/mL. What infusion rate is needed in mL/h?
  56. A patient weighs 75 kg and is 1.85 m tall. According to the WHO classification (underweight below 18.5, normal 18.5–24.9, overweight 25–29.9, obese 30 or more), which category is this?
  57. A patient weighs 56 kg and is 1.6 m tall. According to the WHO classification (underweight below 18.5, normal 18.5–24.9, overweight 25–29.9, obese 30 or more), which category is this?
  58. A 94 kg adult needs a minimum urine output of 0.5 mL/kg/h. What is the minimum expected urine volume over 4 hours?
  59. A 50 kg adult has burns over 40% of the body surface. Using the Parkland formula (4 mL × kg × %TBSA), how much fluid is given in the first 8 hours?
  60. A 80 kg adult has burns over 50% of the body surface. Using the Parkland formula (4 mL × kg × %TBSA), how much fluid is given in the first 8 hours?
  61. A 84 kg adult needs a minimum urine output of 0.5 mL/kg/h. What is the minimum expected urine volume over 6 hours?
  62. A patient weighs 71 kg and is 1.8 m tall. According to the WHO classification (underweight below 18.5, normal 18.5–24.9, overweight 25–29.9, obese 30 or more), which category is this?
  63. A painless, firm, mobile breast lump in a 22-year-old woman is most likely what?
  64. A patient weighing 70 kg is to receive an infusion at 5 mcg/kg/min. The solution contains 3000 mcg/mL. What infusion rate is needed in mL/h?
  65. A patient weighs 64 kg and is 1.7 m tall. According to the WHO classification (underweight below 18.5, normal 18.5–24.9, overweight 25–29.9, obese 30 or more), which category is this?
  66. A 60 kg adult has burns over 50% of the body surface. Using the Parkland formula (4 mL × kg × %TBSA), how much fluid is given in the first 8 hours?

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